艾滋病 (HIV) 的症状与治疗方法

大家好,今天黄医生谈谈艾滋病感染的症状。

HIV症状取决于个体和疾病阶段。

在最初感染后的前2-4周内,患者可能会出现流感样症状, 他们称之为“有史以来最严重的流感”。


这被称为急性逆转录病毒综合征。症状包括发烧,腺体肿胀,喉咙痛,皮疹,疲劳,身体疼痛和头痛。

艾滋病毒症状可持续数天至数周。请记住,这些症状可见于其他常见疾病,您不应仅仅因为体验过它而认为您患有艾滋病毒。还要注意许多早期HIV感染者没有症状。


在HIV感染的早期阶段之后,该疾病进入临床潜伏期,其中病毒在体内发展,但没有看到症状。如果您正在接受艾滋病治疗,那么病毒通常会受到控制,您可能会遇到可能持续数十年的无症状期。如果您感染了艾滋病病毒并且没有接受治疗,那么它将进展为艾滋病。您可能会出现严重的症状,包括体重迅速减轻,反复发烧,大量盗汗,极度疲倦,腺体肿胀,腹泻,口腔溃疡,肺部感染和神经系统疾病。

即使您遇到上述症状,除非您接受检测,否则无法确认HIV。


如果你担心自己有可能跟性(爱)产生接触或正在经历类似状况,请到我们的诊所进行相关咨询和诊测。

与医生预约

HIV / AIDS: The Differences & Myths Surrounding Them

HIV & AIDS in Singapore

There were 434 reported cases of HIV infection among Singapore residents in 2017. Of these cases, 94% were male and 6% were female, and 71% were between 20 to 49 years old. Among ethnic groups, 69% were Chinese, 19% were Malay, 6% were Indian and 6% from other ethnicities.
Sexual intercourse remains the main mode of HIV transmission, accounting for 96% of all cases. Heterosexual transmission accounted for 36%, while 51% were from homosexual transmission and 10% from bisexual transmission.  The number of new HIV cases among Singapore residents has remained consistent at about 450 per year since 2008. These are the latest statistics published by the Government Technology Agency of Singapore, which analyzes data provided by the Ministry of Health.
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What’s the difference between the two? 

HIV is a virus that causes weakening of the body’s immune system. It does so by destroying white blood cells that protect against bacteria, viruses and other harmful pathogens. Without these white blood cells, the body is will no longer be able to defend itself effectively against such infections.
AIDS refers to a spectrum of potentially life-threatening conditions that are caused by the virus, and is the end stage of HIV infection.


How does HIV progress to AIDS? 

HIV infection undergoes 3 stages. The first stage (Acute Stage) may present with flu-like symptoms, fever and a rash. The second stage (Latent Stage) may present with lymph node swelling, but most patients may not have any symptoms at all. The second stage can last anywhere from a few years to over 20 years. Thus, many HIV-infected patients, especially during this stage, may not even know that they have contracted HIV. Last but not least, the third stage is the presentation of AIDS. 
Without adequate treatment, up to 50% of HIV-infected patients develop AIDS within 10 years. Elevated levels of HIV affect the patient’s immune system and prevent it from functioning properly, eventually leading to AIDS. This may result in the individual being more prone to infections. Patients may develop symptoms such as prolonged fever, tiredness, swollen lymph nodes, weight loss and night sweats. Various virus-induced cancers, and opportunistic infections such as tuberculosis and recurrent pneumonia may occur, and these are the leading causes of death worldwide in patients with AIDS.


Who should test for HIV?

Everyone! It is recommended by the United States Centre for Disease Control and Prevention (CDC) that everyone between the ages of 13 to 64 should undergo HIV testing at least once as part of your routine healthcare. However, if your behaviour still puts you at risk even after getting tested, you should consider getting tested again at some point later on. People who engage in higher risk activity should get tested regularly.


Are you at risk?

If you answer “yes” to any of the questions below, you should get a HIV test if not done recently.

  • Are you a man who has had sex with another man?
  • Have you had sex – anal or vaginal – with a HIV-positive partner?
  • have you had more than one sex partner?
  • have you injected drugs and shared needles or works (for example, water or cotton) with others?
  • Have you exchanged sex for drugs or money?
  • Have you been diagnosed with, or sought treatment for, another sexually transmitted disease?
  • Have you been diagnosed with or treated hepatitis or tuberculosis?
  • Have you had sex with someone who could answer yes to any of the above questions or someone whose sexual history you don’t know?

What are some of the HIV tests available?

There are four types of HIV tests available.
1. Nuclecic Acid Test (NAT) 
Also know as a HIV viral load test, this test looks for the actual virus in the blood. If the result is positive, the test will also show the amount of virus present in the blood. NAT is very expensive and thus not routinely used to screen individuals unless they recently had a high-risk or possible exposure and there are early symptoms of HIV infection. NAT is usually considered accurate during the early stages of infection. However, it is best to get an antibody or antigen/ antibody test at the same time to help in the interpretation of negative NAT result. Taking pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) may also reduce the accuracy of NAT.
NAT is able to detect HIV in the blood as early as 1 to 4 weeks (7 to 28 days) after infection.
2. Antigen/ Antibody Test
Also known as a fourth-generation or combination test, this test looks for both HIV antibodies and antigens. Antibodies are produced by the immune system when one is exposed to bacteria or viruses like HIV. Antigens are foreign substances that cause the immune system to activate. In early HIV infection, an antigen called p24 is produced even before antibodies develop.
The fourth generation test is able to detect HIV in the blood 2 to 6 weeks (13 to 42 days) after infection, and is most accurate after a 28-day window period.
3. Antibody test
This is also known as a third-generation test. As mentioned before, antibodies are produced by the immune system upon exposure to bacteria or viruses like HIV.
The antibody test is able to detect HIV in the blood approximately 97% of people within 3 to 12 weeks (21 to 84 days) of infection. If a positive HIV result is obtained from any type of antibody test, a follow up test is required to confirm the result.
4. HIV Pro-Viral DNA Test

The HIV Pro-Viral DNA test can be used in specific situations where there are challenges to getting an accurate HIV diagnosis with other available HIV tests including HIV Antibody tests (3rd Generation HIV test), HIV Antibody and Antigen tests (4th Generation HIV test) as well as HIV RNA PCR test.

It is especially useful in the following situations:

  1. Diagnosing HIV in newborns born to HIV +ve mothers
  2. Elite controllers with undetectable HIV viral load despite not being on anti-retroviral treatment
  3. Individual with sero-negative HIV infections i.e. People who get infected with HIV but do not develop anti-HIV antibodies : see FALSE NEGATIVE HIV ELISA TEST

It can be used for situations where the diagnosis of HIV is challenging. It has a lower false positive rate compared to the HIV RNA PCR test when used for diagnosis and it can be done 10 days post exposure.


Can you share the 4 most common myths about HIV? 

1. HIV is a death sentence. 

This may have been the case several decades ago, where without prompt and adequate HIV treatment, the infection progresses and causes the immune system to weaken, leading to AIDS. However, thanks to advances in modern medicine, most HIV-infected patients today are still able to lead healthy, productive lives and may never develop AIDS.

2. HIV can spread by kissing, sharing of food or close contact. 

It is extremely unlikely to contract HIV via these methods as HIV is not spread by saliva. However, if the person you are in contact with has mouth sores/ulcers, bleeding gums or open wounds then there is a possible risk. HIV is spread by 3 main routes: sexual contact, significant exposure to infected body fluids such as semen, blood, vaginal secretions or breast milk, and lastly, mother-to-child transmission. 

3. HIV can spread through mosquito bites. 

This is completely untrue as the virus cannot survive and replicate within the mosquito’s body.

4. There is no need to use a condom during sexual contact if both partners already have HIV. 

Different strains of HIV exist. If two HIV-infected partners are carrying different strains of HIV, having unprotected sexual intercourse may result in the exchange of these strains, leading to re-infection. Treatment in this situation becomes more difficult as the new HIV strain may be more resistant to the current treatment, or cause the current treatment to become ineffective.


What are the 4 things (facts) we should all know about HIV that we probably don’t know already?

  1. Under the Infectious Diseases Act, it is an offence for people who know that they are infected with HIV or AIDS in Singapore to not inform their sexual partners of their HIV status before engaging in sexual intercourse.
  2. For those who are worried but too afraid to undergo HIV screening, there are 10 clinics in Singapore that offer Anonymous HIV Testing (AHT). AHT is made available so as to encourage more individuals who suspect that they are at risk to go for early HIV screening. There is no requirement to provide any form of personal particulars, even if the test comes back positive.
  3. Persons who plan to engage in high-risk sexual behaviour can reduce their risk of HIV infection by taking Pre-Exposure Prophylaxis (PrEP). This is an oral medication that, when taken correctly, can reduce the risk of HIV transmission through sex by over 90%. Persons who did not take PrEP prior to engaging in high-risk sexual behaviour are eligible for Post-Exposure Prophylaxis (PEP). This is a one month course of oral medications that must be started within 72 hours of the sexual exposure, the earlier the better.
  4. The current tagline in HIV is Undetectable = Untransmittable (U=U). In recent years, there is overwhelming clinical evidence proving that people living with HIV who achieve and maintain an undetectable HIV viral load by adhering to their treatment cannot sexually transmit the virus to uninfected partners. Several large studies had been conducted over a course of 10 years between 2007 to 2016, involving thousands of heterosexual and homosexual couples. In these studies, there was not a single case of HIV transmission from a virally suppressed person to their uninfected partner. This is life changing for people living with HIV. In addition to being able to choose to have sex without a condom, this news allows them to approach existing or new relationships with a sense of liberation. 

Speak to our doctors for professional advice or if you wish to find out more information on HIV and AIDS.
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World AIDS Day 2019 Press Statement

World AIDS Day is a day to remember all those who have lost their lives to the illness. At the end of 2018, it is estimated that 32 million lives were lost worldwide to the disease. WHO had previously set the 90-90-90 target for countries in the world to achieve by 2020, 90% of those living with HIV will know their status, 90% of those who are positive are on ART treatment and 90% of those who are on treatment have undetectable levels of the virus. Let us take stock of what we have been able to achieve thus far.


Since then Singapore has risen to the challenge to achieve those goals.
 Singapore has done well with 2 of the goals – 89% of those who are positive are on ART treatment and 94% of those who are on treatment achieved undetectable viral loads. However, much has to be done to improve on getting those living with HIV to know their status as only about 72% are aware they are positive for HIV.
Thus we need to encourage more people who are at risk of HIV infection to get tested. At Dr Tan and Partners we have been strong advocates of screening of HIV and STIs for at risk persons and provide a non-judgmental and LGBT-friendly environment to discuss your concerns. This is to help to protect their families and their loved ones. It is not uncommon for people that I see in my practice to tell me one of the reasons why they are reluctant to get tested is because they are afraid of what will happen if their families or their loved ones find out.
The other common concern is that they will lose their jobs. Finally there are still many misconceptions about how HIV is transmitted. I have patients who are concerned that because they share food with their families they can transmit HIV to their family which is of course not true. HIV is NOT transmitted via casual contact like sharing of food and drinks or shaking hands.


Of note in Singapore as of 2018, of all those who were tested positive more LGBTs are stepping up to get voluntary testing for HIV (20%) compared to heterosexuals (9%). Also importantly, in all newly diagnosed HIV persons in Singapore both homosexuals (42%) and heterosexuals (43%) contribute equally to number of cases. What this shows is that contrary to what some believe, HIV is NOT a homosexual disease but it is a disease that affects all sexual orientation.
Finally, there is strong evidence from large studies involving thousands of sero-discordant couples (that is one partner is HIV positive and the other partner is HIV negative) who have sexual acts between 2007-2016 showed that there was not a single case of HIV transmission to the HIV negative partner if the HIV positive treated partner has undetectable levels of HIV virus. This highlights the importance of treatment of HIV, that treatment of HIV can be successful in achieving undetectable levels of virus and that transmission of HIV is effectively blocked when levels of the virus is undetectable.


We are proud that our Doctors at DTAP have been actively involved in the fight against the HIV epidemic. Our Anonymous HIV Testing site at Robertson Walk has provided a safe space for thousands of people seeking confidential HIV testing since 2005. Our Doctors were the lead and co-lead authors of the Community Workforce section in the Blueprint to end HIV transmission and AIDS in Singapore by 2030. Our Doctors were also part of the Singapore HIV PrEP Taskforce and helped write the first ever local Singapore guidelines for the clinical management of HIV PrEP.
We will continue this fight until we see a world free of stigma, free of discrimination and hopefully free of HIV.


Dr. Julian Ng

Dr Julian Ng has 10 years of medical practice experience. He currently serves as the Chief Medical Officer of the DTAP Group of clinics in Singapore and Malaysia. He is also a member of the Singapore Men’s Health Society. His special interests are in the field Andrology, especially sexual health. He is currently practising at Dr Tan and Partners (DTAP) clinic at Novena Medical Centre.

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

Descovy As New HIV Medication For HIV PrEP

What is HIV Pre-Exposure Prophylaxis (PrEP)?

HIV Pre-Exposure Prophylaxis (PrEP) is the use of medications to effectively prevent the transmission of HIV. Individuals who are taking PrEP can reduce their risk of contracting HIV infection by up to 99% if taken regularly. This type of medication must be taken before exposure to be effective. It is different from Post-Exposure Prophylaxis (PEP), which is taken immediately after possible exposure and uses additional medications.

PrEP is usually taken as a once-daily combination tablet of tenofovir disoproxil fumarate (TDF) + emtricitabine (brand name: Truvada), although other types of dosing regimens are available as well depending on the unique lifestyle of the individual. Studies have shown that PrEP is generally safe for long term use, but some may experience side effects such as a reduction in kidney function and bone density.

FDA Approved

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

The main difference between Descovy and Truvada is the form of tenofovir drug present – the newer Descovy uses TAF, which enters cells more efficiently than Truvada’s TDF, and means that a much lower dose of tenofovir is needed. This means that other tissues such as the kidney and bone are exposed to a much lower dose of the drug and there is less risk of drug toxicity.

The DISCOVER trial for Descovy as PrEP showed that the new drug is as effective as Truvada in preventing HIV transmission in men or transgender women who have sex with men, when taken as a once-daily tablet. They have not yet performed specific studies to evaluate protection in vaginal sex, or with other PrEP dosing schedules (such as Event-Based Dosing, T’s and S’s, etc.).

However, given that Descovy is essentially just a new and improved Truvada (which has been extensively studied in these situations), it is likely just a matter of time before further studies are done and show similar efficacy.

Descovy also includes a warning in usage as PrEP for patients with known hepatitis B infection, stating a potential risk of hepatitis B exacerbation after stopping the drug. While it can still be used as PrEP in patients with a history of hepatitis B infection, close monitoring of liver function and hepatitis B viral load for up to 6 months following discontinuation of Descovy is recommended (same as Truvada).

Speak To Our Doctors Today!

Descovy is currently available in all Dr Tan & Partners (DTAP clinics) in Singapore. 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. Dr Jonathan Ti, MB, BCh, BAO (Ireland), MRCP (UK), Cert. Men’s Health, is a member of the Singapore HIV PrEP Taskforce and is a co-author of the Singapore HIV PrEP Guidelines and is currently practising at our Robertson Walk Clinic.

HIV PrEP does not protect the user against other STDs. Therefore, even if you are on HIV PrEP, it is important to still to use a condom regularly, as well as get your regular STD screening & HIV Testing.

If you are interested to find out more about HIV PrEPplease call our any of our clinics or drop us an email at hello@dtapclinic.com for an appointment with our doctors.

Apakah Simtom HIV Dan STD?

Hai, Saya Dr. Taufiq dari Dr. Tan dan Partners, dan hari ini saya ingin bercakap mengenai simtom penyakit kelamin atau STD, dan HIV.

Doktor yang boleh berbahasa melayu


Apakah simtom HIV dan STD?

Penyakit kelamin atau STD berpunca dari beberapa jenis virus, bakteria atau kuman yang boleh menjangkiti seseorang melalui hubungan seks dengan pasangan yang sudah pun mempunyai jangkitan tersebut. Penyakit HIV pula berpunca dari virus yang dikenali sebagai Human Immunodeficiency Virus, dan ia juga tersebar melalui hubungan seks.


Simtom-simtom STD

Simtom-simtom STD boleh dibahagikan kepada tiga jenis – simtom semasa kencing, simtom pada kulit dan simtom umum. Simtom-simtom STD boleh mengambil masa yang berbeza untuk muncul – ada yang mungkin seawal 3 hari selepas hubungan seks, ada juga yang mengambil masa beberapa minggu atau bulan untuk menjadi jelas. Ada pula sesetengah orang yang dijangkiti STD, tetapi mereka tidak mengalami apa-apa simtom yang nyata.


Jangkitan Chlamydia dan gonorrhea (CGP)

Jangkitan Chlamydia dan gonorrhea (CGP) adalah penyakit STD yang paling kerap dijangkiti. Antara simtom 2 termasuk pengeluaran cecair dari kemaluan.

Ada juga yang dijangkiti tapi tidak menunjukkan apa2 simtom. Jangkitan ini juga boleh membawa kepada kemandulan.
Di klinik kami di somerset, ada meneyediakan khidmat pemeriksaan CGP pantas.

Anda boleh mendapat keputusan dalam masa 24 jam. Pengesanan awal dapat membolehkan rawatan awal.

Simtom-simtom HIV pula mungkin berbeza bergantung pada individu dan peringkat penyakit.


Simtom-simtom HIV

Bagi seseorang yang mengalami jangkitan HIV peringkat awal, mereka mungkin dapat melihat simtom-simtom tertentu dalam masa 2 hingga 4 minggu pertama.

Simtom yang paling ketara pada peringkat awal ialah selsema yang serius, yang selalu disifatkan sebagai “selsema yang paling buruk yang pernah dialami”.

Keadaan ini dikenali sebagai sindrom retroviral akut, atau ARS. Sindrom jangka pendek ini disifatkan dengan sakit tekak, ruam, keletihan, sakit-sakit badan dan sakit kepala. Simtom-simtom HIV boleh berlarutan dari beberapa hari hingga ke
beberapa minggu.

Selepas jangkitan HIV peringkat awal, simtom-simtom penyakit ini mungkin hilang. Tapi awas, jangkitan HIV mungkin sudah mara ke peringkat kedua yang dipanggil peringkat latensi. Pada peringkat ini, virus HIV membiak di dalam tubuh badan, tanpa menunjukkan apa-apa kesan yang jelas seperti simtom- simtom yang telah saya katakan tadi.

Peringkat terakhir jangkitan HIV dikenali sebagai penyakit AIDS. Pada peringkat ini, fungsi perlindungan dalaman atau sistem imun badan akan mula merosot.

Seseorang yang mempunyai penyakit AIDS akan lebih senang jatuh sakit, dan mungkin juga mati kerana sebab-sebab yang pada asasnya, tidak serius.


HIV Rapid Test

Untuk mengesan jangkitan HIV, ujian pantas HIV (HIV Rapid Test) hanya boleh diambil sekurang-kurangnya 14 hari selepas anda terdedah pada aktiviti berisiko tinggi.Ini adalah ujian generasi ke 4 dimana ia boleh mengesan HIV
seawall 14 hari.

Ujian generasi ke 3 pula memakan masa 90 hari selepas pendedahan sebelum boleh mengesan HIV.


PrEP dan PEP

PrEP (Pre-Exposure Prophylaxis) adalah ubat yang diambil untuk mengelak daripada menjangktii virus HIV. PEP (Post exposure Prophylaxis) pula adalah ubat yang diambil setelah terdedah pada virus HIV.

PrEP biasanya digalakkan bagi mereka yang berisiko tinggi untuk mendapat HIV seperti golongan yang mempunyai pasangan yang berbeza, lelaki yang berhubungan sesama lelaki lain.

PEP pula di galakkan bagi golongan yang terdedah pada HIV. Contohnya kondom yang pecah sewaktu bersetubuh, berhubungan dengan pekerja seks tanpa kondom dan pendedahan pada HIV melalui suntikan jarum. (needlestick injury).

Klinik kami di daerah Orchard Road di Somerset ada menyediakan kedua- dua jenis ujian HIV serta perkhidmatan PrEP dan PEP.


Apa itu HPV

HPV atau Human Papilloma Virus adalah sejenis virus yang merebak melalui sentuhun kulit. Ia boleh menyebabkan ketuat (warts) serta kanser pangkal rahim (cervix).

Kini ada vaksin yang bleh melindungi anda daripada 9 jenis virus HPV. Ia dinamakan Human Papillomavirus 9-valent Vaccine. Human Papillomavirus 9-valent Vaccine adalah satu-satunya vaksin yang boleh mengelak daripada kanser. Ia digalakkan bagi lelaki dan perempuan berumur 12 tahun ke atas.

Kami ada menyediakan khidmat vaksin Human Papillomavirus 9-valent Vaccine di klinik kami di daerah Orchard Road di Somerset.

Saya telah pun memberikan penerangan ringkas tentang penyakit STD, HIV dan AIDS.

Sebelum saya akhiri, saya ingin memberi beberapa pesanan.


Kesimpulannya

  • Pertama, saya ingin menegaskan bahawa simtom-simtom seperti selsema, sakit tekak, sakit badan dan sebagainya, sama seperti simtom-simtom untuk penyakit biasa. Jadi, janganlah tergopoh-gapah untuk menganggap bahawa awak telah dijangkiti penyakit HIV hanya kerana awak ada simtom-simtom tersebut. Pada masa yang sama, saya juga ingin mengingatkan bahawa ramai orang yang dijangkiti penyakit HIV tidak menunjukkan apa-apa simtom yang jelas dan nyata.

Jika awak berasa ragu tentang kesihatan awak, adalah wajar untuk berjumpa dengan doktor yang bertauliah untuk mendapatkan pemeriksaan dan kepastian.

  • Kedua, mujurnya, kini kita sudah boleh merawat dan mengawal penyakit HIV dengan lebih berkesan. Sekiranya anda mendapatkan rawatan untuk jangkitan HIV, anda mempunyai peluang untuk hidup dengan sihat, dan bebas dari simtom-simtom ini untuk masa yang lama.
  • Ketiga, anda hanya akan dapat mengesahkan penyakit HIV dan kesihatan anda melalui ujian khas, tiada jalan lain untuk mendapatkan kepastian ini.

Sekiranya anda bimbang tentang kemungkinan pendedahan, atau anda mengalami simtom-simtom STD dan HIV, sila lawati klinik kami untuk penilaian dan ujian yang betul. Kami sedia membantu untuk memberi nasihat dan rawatan yang diperlukan. Bicaralah dengan dokter Anda hari ini!


Doktor yang boleh berbahasa melayu


Dr. Taufiq at DTAP Clinic @ Somerset

1 Grange Rd,
#10-08 Orchard Building,
Singapore 239693

Telepon: +65 6262 0762

Dr. Ezlyn at DTAP Clinic @ DUO Galleria

7 Fraser St,
#B3-18 DUO Galleria (Bugis MRT), 
Singapore 189356

Telepon: +65 6976 5023

Tag: hiv test

HIV Singapore 2019

In June 2019, the Ministry of Health (MOH) released an update on the HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome) situation in Singapore 2018.
Here are the salient statistics and a short commentary for each.

  • There were 313 new cases of HIV infections reported among Singapore residents in 2018
    • There were 8,295 HIV-infected Singapore residents as of end 2018, of whom 2,034 had passed away.
    • The number of new HIV cases among Singapore residents has been between 400 to 500 per year from 2007 to 2017

The number of cases has dropped slightly – from 400-500 a year to 313 last year. In 2017 it was 434 new cases. In 2016 it was 408 new cases. While no reasons were provided as to why the numbers last year were lower, it is a step in the right direction for organisations like Action for AIDS, which is committed to ending HIV transmission and AIDS in Singapore by 2030. Safer sex practices such as the consistent and correct use of condoms and reducing high-risk sexual behaviour such as being faithful to one’s partner, avoiding casual sex and avoiding sex with commercial sex workers are some ways we can further reduce transmission of HIV. The usage of medications such as pre-exposure prophylaxis and post-exposure prophylaxis (PrEP and PEP) can also reduce the risk of contracting HIV.

  • The age and sex distribution of the 313 cases
    • 93% were male
    • 62% were between 20 to 49 years old

The majority of new cases are men, and usually in the age group of 20-49. Males of this age group might have a tendency to engage in high-risk sexual behaviour. Education about HIV transmission and prevention for everyone, especially for males aged 20-49 is crucial for the aim of reduction of new cases.

  • 95% acquired the infection through sexual intercourse
    • 43% were from heterosexual transmission
    • 42% were from homosexual transmission
    • 10% were from bisexual transmission.

For the first time, the rate of heterosexual transmission was greater than the rate of homosexual transmission for HIV. This could be due to increased awareness of HIV and its transmission in the homosexual population.
A recent local study by researchers from the Saw Swee Hock School of Public Health at the National University of Singapore (NUS) has estimated that around 210,000 men have sexual intercourse with other men, which is more than twice an earlier estimate of 90,000. The researchers have identified four groups that have the highest risk of getting and transmitting HIV, which are
– Males who have sex with other males (210,000)
– Male clients of female sex workers (72,000)
– Female sex workers (4,200)
– Intravenous drug users (11,000)
These are the groups that are most at risk, and are the groups we need to increase screening rates and education about HIV and sexually transmitted infections (STIs) as well.

  • About 50% had late-stage HIV infection when they were diagnosed

HIV can be treated effectively – it is no longer the death sentence it was when HIV was first discovered. We know that the earlier we initiate treatment for HIV, the better the outcomes and life expectancy. All that is required to test for HIV is a small amount of blood and more importantly, ownership of your health. We highly advise everyone who engages in high-risk sexual behaviour regularly test for not just HIV, but other STIs as well.

  • Methods of detection
    • 57% were detected in the course of medical care provision
      • Such cases are typically at the late stage of HIV infection.
    • 22% were detected during routine programmatic HIV screening
    • 14% were detected from voluntary screening.
      • Such cases were more likely to be at an early stage of infection.

When someone presents at the late stage of HIV infection, outcomes and life expectancy are poorer. HIV ideally should never be discovered this way. HIV infection can be completely asymptomatic, especially in the early stages, and the only way to detect infection is to test for it.
The goal is to increase voluntary screening rates so that we can detect HIV early on, before the onset of AIDS. HIV infected people can lead normal, long, healthy lives with proper treatment. HIV testing is available at polyclinics, private clinics, and hospitals. There are also anonymous HIV test sites, where personal particulars are not required when signing up for an HIV test.
The Health Promotion Board (HPB) has been working with partner organisations to conduct educational programmes and campaigns to reach out to high-risk individuals to urge them to go for regular HIV testing. It is good to know that our government is taking steps to increase awareness and increase rates of HIV screening. We should do ours too by taking charge of our health by reducing high-risk sexual behaviour, and getting tested regularly should there be any high-risk sexual activity.


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  1. HIV Elite Controllers And Long-Term Non-Progressors
  2. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  3. What are the Causes of Abnormal Penile Discharge?
  4. An Overview of STD – From an STD Doctor
  5. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  6. Anonymous HIV Testing – What You Need to Know
  7. Low HIV Risk Doesn’t Mean No HIV Risk
  8. What is HPV Vaccination (Gardasil 9)
  9. 10 Causes of abnormal Vaginal Lumps and Bumps
  10. An Overview of Gonorrhoea
  11. What is the Treatment for Cold Sores? What causes Cold Sores?
  12. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  13. Syphilis Symptoms (Painless STD Sores & STD Rashes)

HIV Elite Controllers and Long-term Non-progressors

Elite controllers are defined as those individuals who have been infected with HIV but is able to achieve undetectable levels of virus (<50 copies/ml) without any medication. While long-term controllers are those who have been able to achieve low but detectable levels of HIV (<2000 copies/ml) without treatment.

There are many theories as to how these individuals are able to control the virus:

  • These individuals CD4 cells are less susceptible to infection by the HIV virus
  • Infected with defective strains of the HIV virus that makes the virus less able to produce copies of itself.
  • Individuals’ whose immune system is able to mount an effective response to the virus
  • Individuals’ immune system causes less inflammation when the HIV virus is encountered and thus limiting the exposure of the virus to CD4 cells.

There is a fair amount of evidence to suggest that perhaps the main mechanism that allows for control of the HIV virus is that an effective and potent immune response by an individual. Studies have shown that when only CD4 cells of elite controllers were isolated without CD8 cells, and then infected with HIV virus, the CD4 was just as easily infected as non-elite controllers thus giving evidence that the elite controllers CD4 cells were just as susceptible to HIV infection as non-elite individuals.
In recent months, researchers in Sydney, Australia has reported a case of a known HIV person who has spontaneously cleared HIV infection with no treatment. This patient was infected due to a blood transfusion back in 1981. The patient was able to suppress the HIV virus in his body through his own immune system and have undetectable levels of the virus since 1997. Most recently, they tried to look for traces of the HIV virus in his blood, intestines and lymph nodes but did not detect any traces of the virus, thus the researchers believe this is the first case of spontaneous clearance of HIV infection in humans.

So what factors may have contributed to this patient being able to clear the virus from his body?

  • The virus that originally infected that patient was lacking in a gene called nef. In HIV virus deficient in this gene, the virus replicates more slowly and thus is associated with lower viral loads.
  • The patient was born with 1 copy of a gene called CCR5. The gene is required for HIV to attach to human immune cells. Thus persons with only one copy of the gene would make it more difficult for the HIV virus to attach on to the immune cells. (See: CCR5 HIV Test)
  • It was also found that the patient’s immune cells were naturally more able to recognise a protein called gag made by the HIV virus. This protein is found on the surface of infected human cells. Thus allowing his immune system to better recognise cells that have been infected with HIV virus and aid in their destruction.
  • In addition, the patient was born with 2 specific immune-cell genes called HLA-B57 and HLA-DR13 and in combination allows his immune system to be more effective in responding to HIV infection.
  • As a result of his strong response by his CD4 cells as a result of the presence of the HLA-B57, he is able to mount a bigger immune response by his CD8 cells. CD8 cells are required to activate cytotoxic T cells which as the name suggests are immune cells that kills defective or infected human cells.

In essence, the combined effects of each of the above factors contributed to the clearance of the HIV virus from this particular patient. To replicate this combined effect artificially at this point in time is not possible. However, perhaps in the future with further development of gene therapy, we may be able to achieve this unique set of host factors to achieve clearance of HIV virus.


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  2. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  3. What are the Causes of Abnormal Penile Discharge?
  4. An Overview of STD – From an STD Doctor
  5. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  6. Anonymous HIV Testing – What You Need to Know
  7. Low HIV Risk Doesn’t Mean No HIV Risk
  8. What is HPV Vaccination (Gardasil 9)
  9. 10 Causes of abnormal Vaginal Lumps and Bumps
  10. An Overview of Gonorrhoea
  11. What is the Treatment for Cold Sores? What causes Cold Sores?
  12. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  13. Syphilis Symptoms (Painless STD Sores & STD Rashes)

Tag: hiv test

Sexually Transmitted Infections: More Than 1 Million New Cases Every Single Day

The World Health Organisation (WHO) released a report in June 2019 stating that every single day, there are more than 1 million new cases of curable sexually transmitted infections (STIs) among people aged 15-49 years. These are just from 4 infections – chlamydia, gonorrhoea, trichomoniasis, and syphilis.

This amounts to more than 376 million new cases annually. This is probably a lower number than the actual prevalence in the global population, as these are just the reported cases. On average, approximately 1 in 25 people globally have at least one of these STIs, with some experiencing multiple infections at the same time.

 

About these 4 STIs

Chlamydia and Gonorrhoea

Chlamydia and gonorrhoea are bacterial infections that can be spread through sexual intercourse (oral, vaginal or anal). They can be asymptomatic in some people, but in others can cause urinary symptoms such as penile or vaginal pain, urethral discharge, pain on passing urine, urinary frequency and urgency.

They can also cause irregular spotting in females. The long term complications of untreated chlamydia and gonorrhoea are pelvic inflammatory disease (PID) in females and infertility in both sexes.

 Also Read:

Trichomoniasis

Trichomoniasis is caused by infection by a parasite transmitted during sexual intercourse. The parasite usually infects the lower genital tract (vagina or penis). It can also cause symptoms such as those mentioned above.

Also Read: STD Symptoms in Women

 

Syphilis

Syphilis is a bacterial infection that can result in genital ulcers and a rash. In its later stages, syphilis can affect your eyes, ears, heart, nerves, bones, kidneys and liver. It can cause serious cardiovascular and neurological disease and even death.

Also Read: Signs & Symptoms of Syphilis: Painless STD Sores & Rashes

All four diseases are associated with an increased risk of acquiring and transmitting HIV. Transmission of these diseases during pregnancy can lead to serious consequences for babies including stillbirth, neonatal death, low birth-weight and prematurity, sepsis, blindness, pneumonia, and congenital deformities.

Also Read:

It is important to note that most cases are asymptomatic, meaning people may not have any symptoms at all and are unaware they have an infection if they do not test for these STIs.

 

How Do We Go About Managing These STIs?

These 4 infections are easily detectable, preventable and curable.

STD Testing: There are multiple ways to detect these STIs, but in general, Chlamydia, Gonorrhea and Trichomonas can be detected with a swab test in females or a urine test in males. Syphilis can be detected with a blood test. Read: Comprehensive STD Screening

STD Treatment: After being treated with antibiotics, these infections can be fully cleared from the body. However, because a significant proportion of people can be without symptoms, these infections can go untreated in a person for long periods of time, wreaking havoc on their genitourinary and reproductive tract. These people can also spread these infections to other people, exacerbating this persistent and endemic health threat.

A point to note is that some strains of these infections (Gonorrhoea in particular) are developing multi-drug resistance and evolving into “super-bugs” that are increasingly difficult to treat with current antibiotics. Significant resources are being directed to research in this area, but the most important thing is to get tested and treated early.

 

Who Should Get Tested?

If you have never been tested for STIs before, but have been exposed to sexual encounters in the past, we would recommend you to get tested.

 We also recommend anyone who has had a new sexual encounter to get tested, even if you had used condoms. While it is true that condoms greatly reduce the risk of transmission of STIs, it does not absolutely foolproof as unsurprisingly in the real world they are not always used perfectly.

 Of course, if you have any symptoms, please do get tested and treated.

 

Other STIs

The above 4 STIs are just 4 of the many STIs that you can acquire through sexual contact. There are other STIs that we are concerned about. Other STIs such as the Human Immunodeficiency Virus (HIV), Herpes Simplex Virus (HSV), Hepatitis B and Hepatitis C, Human Papillomavirus (HPV), Chancroid, Molluscum, Pubic Lice and Scabies are some others that we are also concerned about.

It is important that sexually active individuals read up and learn about these STIs to know the signs, symptoms, and modes of transmission to better protect themselves. Knowing more about these STIs will also encourage a person to get treated early should they develop such symptoms.

 

How Do You Reduce Your Risk of Contracting These STIs?

Abstinence is the only way to reduce your risk to zero.

If you are sexually active, use barrier protection such as condoms, the right way. You can also speak to your partner to get tested for STIs before engaging in sexual activity.  A mutually monogamous relationship also carries a lower risk of STIs than having multiple sexual partners.

 If you are sexually active with multiple sexual partners, get yourself tested regularly and treated. The presence of one STI can increase your risk of contracting another one more easily. Most STIs can easily be detected through swabs, urine or blood tests at your doctors. These are rather pain-free and minimally invasive, so there should be no fear to get tested!

There are some STIs that are preventable through vaccinations. HPV Vaccines are available against certain strains of HPV that may cause warts, cervical, anal and penile cancer. Effective vaccines against Hepatitis B are available as well.

 

Conclusion

In summary, the WHO has highlighted the 4 STIs specifically as they are the one which can be completely eradicated from the body if treated properly. But there are other STIs that we should be concerned about too. The best thing you can do is to protect yourself against these STIs through the above-mentioned suggestions.

Get yourself tested regularly if you have new sexual partners. If you have any symptoms, get yourself treated early, and avoid sexual contact until you have been treated and cleared by the doctor as well. 

Take Care & Stay safe!


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  10. What is HPV Vaccination (Gardasil 9)
  11. 10 Causes of abnormal Vaginal Lumps and Bumps
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  13. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  14. Syphilis Symptoms (Painless STD Sores & STD Rashes) 


Also see: wart removal singapore, hiv screening, std check up singapore

What are the Common Misconceptions that People have about HIV?

There are multitude of misconceptions associated with HIV. These are some of the most common ones:
1) HIV is the same as AIDS. HIV (Human Immunodeficiency Virus) refers to the virus itself, whereas AIDS (Acquired Immunodeficiency Syndrome) refers to a spectrum of potentially life-threatening conditions that are caused by the virus.

Read: HIV, AIDS & Opportunistic Infection

2) HIV is a death sentenceThis may have been the case several decades ago, where without prompt and adequate treatment, the infection progresses and causes the immune system to weaken, leading to AIDS. However, thanks to advances in modern medicine, most HIV infected patients today may never develop AIDS. This is why it is imperative to be on treatment, ideally as soon as possible after a diagnosis of HIV is made. It is also important to undergo regular HIV screening.

READ: HIV Treatment & Management

3) HIV can be spread by kissing, sharing of food or close contact. It is extremely unlikely to contract HIV via these methods as HIV is not spread by saliva. However, if the person you are in contact with has mouth sores/ulcers, bleeding gums or open wounds then there is a possible risk. HIV is spread by 3 main routes: sexual contact, significant exposure to infected body fluids/tissues such as semen, blood, vaginal secretions or breast milk, and lastly, mother-to-child transmission.

READ: How Long Can HIV Survived Outside The Body


Is a person infected by HIV any different from that of an uninfected person?

With or without treatment, a person infected with HIV may not appear any different from that of an uninfected person.
HIV infection undergoes 3 stages. The first stage (Acute Stage) may present with flu-like symptoms, fever and a rash. The second stage may present with lymph node swelling, but most patients do not have any symptoms at all. The second stage (Clinical Latency) can last anywhere from a few years to over 20 years. Thus, many HIV infected patients, especially during this stage, may not even know that they have contracted HIV. Lastly, the third stage is the presentation of AIDS symptoms.
HIV infected patients should receive prompt long term treatment and undergo regular follow up blood tests in order to reduce the viral load in their bodies to low levels. This allows their immune system to continue to function well and minimizes the risk of progression to AIDS. By doing so, they can essentially live very normal lives not any different from that of an uninfected person.

What are some of the treatments that a patient will receive upon diagnosis of HIV infection?

Upon diagnosis of HIV infection, a patient will have to start taking a combination of long-term daily medications. These are antiviral medications that work to prevent the virus from replicating. The patient will then be required to return regularly for blood tests to monitor the levels of HIV and the immune system. The goal of treatment is to keep the levels of HIV low, and thus allow the immune system to continue to function well.

How does AIDS affect a person’s health? What do AIDS patients die of?

Without adequate treatment, up to 50% of HIV infected patients develop AIDS within 10 years. Elevated levels of HIV affect the patient’s immune system and prevent it from functioning properly, eventually leading to AIDS. This may result in the individual being more prone to infections. Patients may develop symptoms such as prolonged fever, tiredness, swollen lymph nodes, weight loss and night sweats. HIV Related Opportunistic infections such as tuberculosis, recurrent pneumonia and esophageal candidiasis,  may occur as well. AIDS patients could also develop various viral-induced cancers.
The leading causes of death worldwide in patients with AIDS are, as mentioned, opportunistic infections and cancer.

Recently it was reported that in London, an HIV patient who underwent a bone marrow transplant subsequently had undetectable HIV levels. Does this mean that he is fully cured of HIV?


This is the 2nd ever reported case of an HIV patient being “cured” of HIV. In 2007, a patient in Berlin was also reported to have been cleared of the virus. Both of these cases have similarities: both HIV infected patients concurrently suffered from cancer (Berlin patient had Acute Myeloid Leukaemia; London patient had Hodgkin’s Lymphoma) and both patients received bone marrow transplant by donors who carried the rare CCR5 genetic mutation.
CCR5 is a protein on the surface of white blood cells that is involved in the immune system. It is one of the co-receptors that HIV uses to enter target immunological cells. This means that via CCR5, HIV is able to gain a mode of entry into a person’s immune system. People with CCR5 genetic mutation have resistance to HIV infection because the virus is unable to enter into their immune system like it usually does.
In the case of the London patient, subsequent blood tests have shown that the virus cannot be detected. However, this does not necessarily mean that he has been fully “cured” – the virus may simply be in a dormant, or “sleeping” state.
While the outcome was favourable in the two examples stated above, this form of treatment is not a viable large-scale strategy because bone marrow transplants carry significant risks and are extremely costly. However, it is undeniable that these two cases are landmark moments in the war against HIV as scientists continue to hunt for a cure. The hope is that by conducting more research on the editing of the CCR5 gene, we will one day be able to develop a safe, cost-effective and easy solution.

READ: HIV CCR5 Mutation & CCR5 Testing

Do you think that mankind can eradicate HIV eventually? Before this happens, what kind of support can we give to HIV infected patients?

I believe that with continued advances in medical research, there is hope of a cure for HIV in the future. However, this is a long and slow process that may require many years or decades. Until then, the best option is to ensure that the public are able to gain access to undergo HIV screening even if the risk is not high, and that HIV infected patients are able to receive prompt and long term treatment.
From the initial shock and disbelief of receiving a diagnosis of HIV; having to accept the reality of the situation; to having to live with HIV daily, these are just a few examples of the tremendous challenges that HIV patients face in their lives, and for many patients these have a detrimental impact on their psychosocial well-being.
There is still a terrible stigma today surrounding HIV, and it remains very much a taboo subject that most people are afraid to speak about or face up to. Nevertheless, we can offer many forms of support for HIV patients. For starters, government and healthcare organisations need to continue in their best efforts to increase awareness and educate the public about HIV and its misconceptions. If you have a family member or loved one who lives with HIV, the best kind of support would be your understanding, care and acceptance.
Lastly, if you are a person living with HIV, do not despair. Seek the appropriate treatment that you require, and turn to your family and friends for moral support.
Take Care!
Tags: hiv screening singapore, hiv test


Other Interesting Reads:

  1. HIV Elite Controllers And Long-Term Non-Progressors
  2. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  3. What are the Causes of Abnormal Penile Discharge?
  4. An Overview of STD – From an STD Doctor
  5. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  6. Anonymous HIV Testing – What You Need to Know
  7. Low HIV Risk Doesn’t Mean No HIV Risk
  8. What is HPV Vaccination (Gardasil 9)
  9. 10 Causes of abnormal Vaginal Lumps and Bumps
  10. An Overview of Gonorrhoea
  11. What is the Treatment for Cold Sores? What causes Cold Sores?
  12. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  13. Syphilis Symptoms (Painless STD Sores & STD Rashes)
  14. HIV Pro-Viral DNA Test