A Case of HIV from Vampire Facial

Our clinics recently diagnosed a case of HIV from a vampire facial.
A Vampire Facial is a type of cosmetic treatment that was made popular by celebrity Kim Kardashian.
The treatment involves taking the patient’s own blood and spinning it down until the cells separate out of the liquid portion (plasma). Small needles known as micro-needles are then used to make multiple small holes in the patient’s face. The plasma is then poured over the face so that it soaks into these holes.
Two cases of HIV infection from such treatments were reported earlier this year in Albuquerque, New Mexico in the US. https://www.medscape.com/viewarticle/912436
Vampire Facial treatment is NOT approved in Singapore.

What Can You Do to Protect Yourself?

Before undergoing a treatment, ensure that the establishment has all the proper local licenses required.
Ensure that the therapist conducting the treatment has all the training certifications required.
Do not undergo any treatments in non-medically licensed establishments that involves blood or body fluids.
For treatments that involve puncturing or breaking the skin, ensure that the instruments used are properly packaged and sterilized. 
Insist on seeing the operator open the sealed package in front of you.

If you feel you might have been exposed to an infection, see your local Doctor immediately for a discussion on HIV PEP and screening for other blood-borne infections like Hepatitis B and Hepatitis C.


Learn More about Other STDs & Other STD Symptoms

When To Test For HIV During or After Completing HIV PEP

HIV Post-Exposure Prophylaxis (PEP) has been established as a cornerstone of HIV prevention in the last 20 years. With newer, well-tolerated medications and better access to medical care, PEP has shown itself to be a safe and effective weapon in our arsenal against HIV infection.

Read: A Guide to HIV PrEP & HIV PEP (Pills for HIV Prevention)

For those individuals who have been in the unfortunate position of needing PEP, the next question is invariable:

When can I test for HIV after I finish PEP?

There are very few studies that have examined the “earliest time” you can do an HIV test after taking PEP and have conclusive results. There are some theories that taking PEP can increase the window period for testing by delaying the appearance of HIV antigen or antibodies in the blood – these have neither been proven or debunked, although evidence is weighted towards the latter.
Current data would suggest that p24 antigen and antibody response is not significantly affected by these antiviral medications, but these studies have mainly been done on individuals taking Pre-Exposure Prophylaxis (PrEP). As the medications used for PrEP and PEP are essentially the same, we can extrapolate this data to post-PEP testing as well. Confounding factors to these studies include patient adherence to PrEP/PEP regime as well as any instances of ongoing high-risk exposures during the course of medication and/or after.

Immediately After Completing PEP

Both the US CDC 2016 guidelines and joint WHO/ILO 2005 guidelines for PEP recommend HIV testing at baseline before starting medication and immediately after completing PEP (i.e. 4 weeks post-exposure as per regular non-PEP users), as well as 3-6 months post-exposure.
Importantly, the US CDC guidelines also states that patients keen to start on HIV PrEP after their HIV PEP can do so immediately following the completion of 28-day PEP, and provided the patient has a negative 4th generation HIV Antigen/Antibody test: “Because no evidence exists that prophylactic antiretroviral use delays seroconversion and PEP is highly effective when taken as prescribed, a gap is unnecessary between ending PEP and beginning PrEP.” Again, this suggests strongly that testing immediately after completing PEP is sufficiently conclusive to exclude an HIV infection.
Some studies done in animals have shown HIV DNA/RNA PCR testing during HIV PEP can sometimes even show a positive HIV viral load, with follow up testing after completing the medication showing a negative result. This could represent a successfully aborted infection, which is exactly the point of PEP in the first place.
We do not usually recommend HIV DNA/RNA PCR testing during or after completion of HIV PEP, as we know that the medication can and will suppress the viral load the same way it does in chronic HIV infection – this means that even a negative PCR viral load test may be a false negative, with viral load increasing again in a true infection a few months after the medication has been stopped.

Read: HIV Window Period (Timelines for Accurate HIV Test)

Personally, I have not encountered any patients who have taken PEP and tested negative at 28 days to subsequently have their results change to HIV positive in follow-up testing, except in a single case where the patient had ongoing high-risk exposures during and after their PEP medication.

Read: How to Get An Anonymous HIV Test in Singapore

In summary, post-PEP testing can be performed immediately following the completion of medication (i.e. 28 days or more post-exposure) with a 4th generation Antigen/Antibody test with good certainty, although guidelines will still recommend one last test at 3 months or more post-exposure as a precaution.
Current clinical experience indicates that the test at the end of PEP is essentially conclusive and sufficient to ensure that PEP is successful and HIV infection has been prevented, but higher-powered studies are required to confirm this.
It is still best to speak to the doctor who prescribed you the PEP or who will be following up with your care, as they will be most familiar with local testing methods and guidelines.
If you believe you have had a potential high-risk exposure within the last 72 hours, you may consider Post-Exposure Prophylaxis (PEP). Please contact us for a consultation if you think you need PEP.
If you have any questions or concerns, please visit our online forum on sexual health, HIV and STDs.
If you wish to speak to any of our doctors in regards to HIV PEP or HIV Testing, you can visit any of our clinics or drop us an email at hello@dtapclinic.com for an appointment.
Take Care!


Other Reads:

  1. Low HIV Risk Doesn’t Mean No HIV Risk
  2. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  3. What are the Causes of Abnormal Penile Discharge?
  4. HIV PrEP for Travel – How You Need to Know
  5. An Overview on STD from an STD Doctor
  6. Why Do I Have AbnormalVaginal Discharge
  7. How Late Can a Period Be (Delayed Menstrual Cycle)
  8. Everything You Need to Know about Herpes Simplex Virus
  9. How Do I Treat Oral Herpes (Cold Sores)
  10. Syphilis Symptoms – Painless Sore & Ulcers
  11. HIV Symptoms – What You Need to Know
  12. 10 Common HIV related Opportunistic Infections
  13. HIV Pro-Viral DNA Test


HIV Transmitted Risk – A quick overview

The neighbouring country has just built a wall to keep outsiders out. These outsiders do not have a passport and are trying to get over the wall through different means. The HIV virus is one of these outsiders, they will try all means to get across the wall
We will discuss in this article,  the vehicles the HIV virus can adopt to get over your wall. From taking a plane and DEFINITELY getting over the wall, to taking a ship around the border and MAYBE getting around the wall and lastly climbing over the wall which is NOT possible.
The HIV virus will need a vehicle to get past the wall and in the medical context, the HIV virus from a positive person will need to come into contact with a negative person. The fluids which carry the most viruses are blood and semen whereas saliva and vaginal fluid hold much less of the HIV virus.
DEFINITELY getting over the wall – definite transmission, for every 10,000 attempts this will be the number of times successful the HIV virus will get over the wall and cause infection during that activity

  • Blood transfusion – 9250/10000 (although this is rare, it still happens: https://www.bbc.com/news/world-asia-india-36457517).
  • Needle sharing in intravenous drug use – 63/10000.
  • Needlestick injury – 23/10000.
  • Receptive anal sexual intercourse – 138/10000.
  • Insertive anal sexual intercourse – 11/10000
  • Receptive penile-vaginal sexual intercourse – 8/10000
  • Insertive penile-vaginal sexual intercourse – 4/10000
  • Receptive and insertive oral sexual intercourse – low (too low for accurate numbers).

According to the Singapore Ministry of Health UPDATE ON THE HIV/AIDS SITUATION IN SINGAPORE 2014.

Estimated risk per exposure to HIV transmission: assume that the ‘source partner’ is always HIV-positive. For a partner of unknown status, the risk is affected by the prevalence of HIV in the relevant community – i.e., the chance that the partner does, in fact, have HIV. Unless otherwise stated, the sexual acts are always without a condom.

MAYBE getting around the wall – theoretical situations where there isn’t enough scientific data on where the HIV virus may get around the wall

  • Presence of blood getting into contact with an open wound, ulcer – this is a possibility but the risk is lower and unlikely. Open wounds should be treated early to reduce the risk of other infections such as bacterial infections. The risk of bacterial infections into an open wound is often higher than the risk of an HIV infection.
  • Blood getting into contact on mucosal membrane surfaces such as the eyes or mouth – this is again a possibility, but extremely unlikely
  • Dried blood on surfaces – some studies have shown that the HIV virus can survive in dried blood for a few days. However for that blood to infect another person, it would have to cross a thick layer of the person’s skin, mucous membranes and get into the bloodstream. The environment has to favourable for this to happen and transmission through dried blood is often very unlikely.

NO WAY of getting over the wall – not possible for transmission

  • Being in the same room as an HIV positive person and breathing the same air
  • Sitting on a toilet seat or touching a door handle
  • Hugging, Kissing (not french kissing), Shaking hands
  • Drinking from the same water cooler, water fountain
  • Sharing of food utensils.
  • Sharing equipment at the gym
  • Biting or scratching superficially that does not break the skin surface or draw blood.
  • Skin to skin contact with another person

We hope this short illustration answers and highlights questions people may have over possible ways of HIV transmission. Fluid-fluid contact is necessary for transmission and without this, there is NO risk for HIV transmission.
If you have any new questions, please feel free to ask them on https://www.dtapclinic.com/forum/
Take Care!


Other Reads:

  1. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  2. What are the Causes of Abnormal Penile Discharge?
  3. HPV Infection & HPV Vaccination for Men who have sex with Men
  4. STD Risk for Receptive Unprotected Anal Sex in Men
  5. Low HIV Risk Doesn’t Mean No HIV Risk
  6. HIV PrEP for Travel – How You Need to Know
  7. An Overview on STD from an STD Doctor
  8. Everything You Need to Know about Herpes Simplex Virus
  9. How Do I Treat Oral Herpes (Cold Sores)
  10. Syphilis Symptoms – Painless Sore & Ulcers
  11. HIV Symptoms – What You Need to Know
  12. 10 Common HIV related Opportunistic Infections
  13. The HIV Pro-Viral DNA Test can be done 10 days post exposure.


A Guide To HIV PrEP and HIV PEP – Pills for HIV Prevention

Nearly every day here I see a person who is super anxious and has put their life on hold for anywhere from a month to three months in fear that they have contracted HIV from a momentary lapse of judgement. You can lose sleep, your appetite, your hair can fall, you can be visibly emaciated as well with this amount of stress in life on a daily basis for such a long period.
When it comes to staying safe against HIV in a lifestyle where one is exposed to the virus, it is crucial that one adopts multiple precautionary measures against transmission of HIV.
Apart from choosing partners wisely (we always encourage STI testing prior to being sexually active with someone) and using condoms, there is an additional safety precaution when it comes to safeguarding yourself against HIV transmission.
So in this article, let’s talk about the HIV medication you can take to help protect yourself against HIV. Basically, this is a lifestyle choice that you’d have to make based on as much information as possible. Let’s go over some of the details right.

First off, what is HIV and why are we so worried about it?

Would you like to hear the scary part first? Basically, after decades of studying the virus, we still do not have a cure for it. Now, that doesn’t mean everyone with HIV will die of HIV complications but more that if you do pick up HIV sometime in your life, chances are you’ll die with the HIV still in you. How’s that for a daily nightmare?

HIV Infection

HIV stands for Human Immunodeficiency Virus. HIV is a virus spread through certain body fluids that attacks the body’s immune system, specifically the CD4 cells, often called T cells. Now, once the virus starts infecting the cells, it goes on a continuous rampage of self-replication and destruction. Basically the more of the virus that is present, the worse of an infection it can create. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. Untreated, HIV reduces the number of CD4 cells (T cells) in the body. This damage to the immune system makes it harder and harder for the body to fight off infections.
So imagine your body is fighting a losing battle with HIV, other bacteria, virus and fungi know that your body is already weakened and they do attack the body at that time. These are called opportunistic infections.
So in combination of HIV and opportunistic infections (see: 10 Common HIV Opportunistic Infections), the body gets worn down over time until it succumbs to these infections.

What is AIDS (Acquired Immuno-Deficiency Syndrome)?

AIDS is the most severe phase of HIV infection; basically, it’s the bigger, older, more aggressive older brother that will stop at nothing until your organs cease to function as intended.

HIV mode of transmission

Only certain body fluids—blood, ejaculate or pre-ejaculate material, rectal fluids, vaginal fluids, and breast milk—from a person who has HIV can transmit HIV. Bear in mind that a simple contact or a touch gesture does not guarantee transmission of the virus. These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream (from a needle or syringe) for transmission to occur.

How Would I Know if I Picked Up the Virus?

Acute Retroviral Syndrome (ARS) – Initial HIV symptoms
There are a few stages to an HIV infection. The very first few symptoms can occur within five to 12 days of exposure to the virus. This is the ARS (Acute Retroviral Syndrome) phase. Now this stage is particularly challenging to diagnose because more often that now, you wouldn’t even go through this phase.
In the off chance that you do have ARS, the symptoms can be so vague and misleading that it may be discarded as something completely different if you do not provide a history of a situation where you might have picked up HIV.
If at any time after a potential exposure episode you happen to develop features as listed below, it would be wise to seek medical attention as soon as you can.

  1. Fever – This is usually a high-grade temperature (>38.5) accompanied with chills, tremors, and the occasional night sweats
  2. Rash – Look out for an upper chest angry rash that is reminiscent of a chicken pox rash. Think red, fast growing, vesicular like rashes that can be painful or uncomfortably itchy in general.
  3. Muscle aches – That feeling that your body is heavy and you just don’t want to get out of bed.
  4. A sore throat
  5. Swollen lymph nodes – Look out for any abnormal swelling around your neck, behind your neck and under your armpits especially
  6. Mouth ulcers

So ideally these HIV symptoms will all come in about the same time with a recent history of potential exposure. This can prompt your physician towards a diagnosis of HIV ARS.
It’s also important to recognise which stage the virus is in so we can expect certain infections and treatment with the aim of covering as wide a net as possible when dealing with HIV.

You can learn more about HIV Window Period & False HIV Positive in this video:

That being said, we’re here to emphasize protecting yourself against HIV instead of being vulnerable to it and its effects on life in general. As I earlier mentioned, nearly every day we see people who lose weeks worth of sleep being so anxiously paranoid that they might have picked up HIV.
The ideal would definitely be the prevention of HIV transmission to begin with.

We’ll start with Pre-Exposure Prophylaxis (PrEP)

This is where the modernisation of medicine plays a huge part in society. The idea of Pre-exposure prophylaxis or PrEP is that it works similar to how a vaccine would in terms of offering protection against a disease.
The premise is simple. You take a tablet once a day and if taken correctly; combined with safe sexual practices, and there are no other complications, there is an up to 99% chance you will not get HIV if ever exposed to the virus.
HIV PrEP is basically using anti-retroviral medication (basically HIV medications) to prevent the acquisition of HIV infection by an uninfected person. PrEP is offered here in the form of a combination tablet containing tenofovir and emtricitabine (both medications we use to treat HIV).

Descovy As New HIV Medication For HIV PrEP

Descovy (brand name) is a FDA approved new drug combination of tenofovir alafenamide (TAF) + emtricitabine for use as HIV PrEP, which has shown to be equally effective in preventing HIV infection whilst touting an improved safety profile for renal and bone toxicity.

Descovy is currently available in all Singapore Dr Tan & Partners (DTAP clinics) only. It is a prescription-only medication and must be prescribed by a doctor. Speak to our doctors for more information about Descovy and find out if a HIV-1 treatment that contains Descovy is right for you.

Can Anyone Take HIV PrEP?

HIV PrEP was initially created for people who are in the high risk group for contracting HIV. This included people whose spouses were HIV positive . Trying to have a healthy relationship is trying enough as it is. HIV PrEP allows for intercouse with a significant less amount of stress and worries about contracting HIV.
Among other people who are in this high risk group include people who:

  • are sexually active in the last 6 months and NOT in a sexually monogamous relationship with a recently tested HIV-negative partner, and who
    • is a man who has sex with men, and who… (see: STD risk from unprotected Anal Sex in Men)
      • engage in anal sex
      • has had a sexually transmitted infection in the past 6 months
    • or is a sexually active adult (male or female with male or female partners), and who…
      • is bisexual (riskier if you have a very active sex life with multiple partners at the same time)
      • has sex with partners at increased risk of having HIV (e.g. injection drug users, men who have sex with men) without consistent condom use.

As we have evolved into prescribing PrEP, we realised that the level of protection it offers should not be confined to a certain group of people but to anyone who is wanting that added layer of protection against HIV transmission.
So really, all you have to do is to speak to your doctor, undergo a few simple tests to ascertain that you are healthy and have had no exposure to HIV prior to that before starting PrEP.
When you first start PrEP you may experience side effects like:

  • nausea
  • dizziness
  • headaches
  • fatigue
  • stomach cramps

More serious side effects include:

  • kidney problems, including failure
  • Liver problems
  • Reduced bone density

This is why, when on PrEP, it is important to regularly monitor the health of the organs that can be affected by this medication. We’ll have to get regular blood and urine screening is done with regular HIV testing and also bone scans if necessary in some cases. It is always best to continue on these medications with the advice of a physician.
Both our Robertson Walk (Singapore) & KL Eco City (Malaysia, Kuala Lumpur) provide Anonymous HIV Testing if you wish to keep your HIV status anonymous.

Frequently Asked Questions of HIV PrEP

1. Can I get STD even if I am on PrEP?

Yes, of course. HIV is just one type of a STI. There are other STI that aren’t even viruses but are bacteria. In these situations, taking PrEP is irrelevant to the situation. PrEP is designed to protect you against specifically HIV, not all STIs.

2. Do I still need condom even if I am on PrEP

Safe sex practices are always encouraged regardless if you are on PrEP or not. Basically, it is better to be safer really. Using a condom adds another barrier of safety in terms of picking up an HIV infection so really, why compromise on that?

3. Do I need regular HIV testing?

This is indeed encouraged. Its best to go for regular routine check-ups & HIV Testing and discuss your lifestyle and potential risk encounters with your physician to clarify any doubts. We’d also need to confirm that you are not already exposed to the virus before or during your time on PrEP.

4. When can I stop PrEP?

Basically, you can determine that. At any time when you see your lifestyle as not posing a risk of you contracting HIV, you may decide to stop taking the medication. There is no hard and fast rule to this. You can be taking the medications for months or decades if you choose to do so.
Either way, it is imperative that you are safe and in good health whilst taking the medication.

5. Do I have to take it on a daily basis?

Taking PrEP on a daily basis is recommended. This is to ensure compliance to the medication and to allow it to build some sort of protection against the virus. However, if your lifestyle does not call for it, you can choose to do event-based dosing where you take a total of four tablets spaced out over four days before and after a risky encounter.
Obviously, this is less stable a method of acquiring protection against HIV but it is an alternative to people who choose not to take medications on a daily basis ie people who have sexual encounters infrequently.

 Here’s a video on Event Based Dosing for HIV PrEP

Now what is HIV Post-Exposure Prophylaxis (PEP)

So now that we have covered PrEP, let’s move on to PEP (Post Exposure Prophylaxis). This is again a very similar ideology to PrEP where we aim to provide as much protection against transmission of HIV to you. Where it differs is that pre-exposure means before an incident that potentially made you vulnerable to HIV whereas post exposure is the period immediately after you have been potentially exposed to the virus.
Early on in this article, I recounted my experiences dealing with very anxious clients who have lost a weeks worth of sleep because they had to wait out the window period to test for HIV (this is at the least ten days).
This is where PEP comes into play. If for whatever reason you feel that you have been exposed to HIV, come in, see your doctor and get PEP prescribed to you within 72 hours of that and if taken correctly, there is an up to 99% chance you will not get infected with HIV.
See the difference? Immediate action within 72 hours after an HIV potential exposure episode can save you weeks worth of anxiety.
So let’s recap what some potentially dangerous incidences are, shall we? If you are in a position where:-

  1. you think you may have been exposed to HIV during sex (for example, if the condom broke), or if you are unsure about your partner’s status
  2. there was an abnormal exchange of body fluids – exposed to blood during intercourse or you noticed open cuts and active bleeding from your partner
  3. shared needles and works to prepare drugs (for example, cotton, cooks, waiter, medical personnel), or
  4. were sexually assaulted

All of the above are just some examples of a risky contact situation which can potentially transmit HIV to you and these are situations where if you have not already been on PrEP, it is advised to get PEP to safeguard against HIV infections.

How do I take PEP?

HIV PEP is a combination of three drugs likely given to you in two tablets. This is similar to PrEP but with the addition of another agent to the regime. Like aforementioned, time is of the essence when it comes to PEP so be quick to get to it and start taking it well within the 72 hours golden period for the best results.
The medications should be taken once or twice daily for a minimum of 28 days consecutively. Keep in mind that this is crucial. Missing out on one dose or even worse, one day’s worth of PEP is definitely not advisable. (HIV PEP is available in all our clinic in Singapore and Malaysia)

How does PEP work?

Essentially, PEP will prevent the replication of HIV in the body. When it cannot replicate, it cannot create a strong enough infection to overwhelm the body’s immune system. Ideally, that will result in the virus eventually dying off because it is unable to further survive in the body with its presence there being insignificant.

How would I know if PEP worked?

As with any medication, we will have to do pre and post therapy testing. Prior to starting PEP, it is ideally advised to get HIV testing done to make sure you have not already been exposed to HIV. Once you have started the medication, try and take them at the same time everyday for at least 28 consecutive days then we’ll have to get you tested within the next two months.
If throughout that time you appear to be well and there is no evidence of HIV picked up in your tests, we can clear you from that particular incident.

Side effects of PEP?

Because the medication regime is somewhat similar to PrEP, you can expect a similar range of side effects but this may be amplified somewhat. Apart from that, it is fairly undramatic.

Can HIV PEP fail?

Yes, unfortunately, there have been reported cases of PEP failure. This means that even with taking medications, the client still got a HIV infection. This is not common and is usually linked to poor compliance or a pre-existing medical condition that may impair the way PEP works.

All in All

To summarise, there are ways to protect yourself from potentially deadly viruses like HIV. You have to be in the know and be responsible for your own health in terms of how you choose to live your life and how to best be safe in it.
As a physician, I am glad to help you out in every step of the way in getting you as safely healthy as possible while allowing you to lead the life you feel will make you happiest and to achieve your full potential.
It is certainly debilitating to catch a virus like HIV when you’re just out doing what you do. It can throw a spanner into your life goals and bring life as you know it into a screeching halt.
Having said that, I hope this article has given you at least a rudimentary idea of how to keep yourself protected and to stay safe. Remember, prevention is always better than cure.
Take care.
This Article is Written By Dr. Kaarthig Ganesamoorthy from Our KL EcoCity Branch in Kuala Lumpur.


Other Reads:

  1. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  2. What are the Causes of Abnormal Penile Discharge?
  3. HPV Infection & HPV Vaccination for Men who have sex with Men
  4. STD Risk for Receptive Unprotected Anal Sex in Men
  5. Low HIV Risk Doesn’t Mean No HIV Risk
  6. HIV PrEP for Travel – How You Need to Know
  7. An Overview on STD from an STD Doctor
  8. Everything You Need to Know about Herpes Simplex Virus
  9. How Do I Treat Oral Herpes (Cold Sores)
  10. Syphilis Symptoms – Painless Sore & Ulcers
  11. HIV Symptoms – What You Need to Know
  12. 10 Common HIV related Opportunistic Infections
  13. The HIV Pro-Viral DNA Test can be done 10 days post exposure.