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Risk of HIV Transmission Through Blowjob

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A recent news report by Channel News Asia titled “HIV-positive man who donated blood during pandemic faces charge of lying about sexual history” may have caused some concern in the community with regards to the issue transmissibility of HIV through oral sex.

Based on the report, people may wonder just how transmissible is HIV via oral sex and how does it compare to other forms of sexual practices like vaginal sex.

Sexual Practice and HIV Transmission Risk

Based on the Department of STI Control Clinic in Singapore, the table below summarizes the risk of transmission of HIV based on the type of sexual practice.

Sexual Practice Estimated risk of HIV transmission from a known HIV-positive individual not on effective HIV treatment

 
Receptive vaginal sex 10 per 10,000 persons
Insertive vaginal sex About 8 per 10,0000 persons
Performing oral sex < 1 per 10,000 persons
Receiving oral sex < 1 per 10,000 persons

 

Can HIV be transmitted via oral sex yes, but the risk is roughly 10x less likely than vaginal sex.

 

So when is there no risk of HIV transmission?

  • Breathing the same air as someone.
  • Touching a toilet seat or door knob.
  • Drinking from a water fountain.
  • Hugging, kissing or shaking hands (although kissing may transfer fluids the level of virus in saliva is so low as to make the risk negligible).
  • Sharing food or utensils.
  • Sharing gym equipment.
  • Skin to skin contact with an HIV positive person even if they happen to have fluid of unknown origin on them (particularly applies to commercial sex workers).
  • Biting or scratching that does not break the skin or draw blood

 

How can we reduce risk of HIV transmission?

  • Monogomous relationship
  • Avoid casual sex or paid sex
  • Always use condoms
  • Regular testing if you are at risk – protect yourself and your loved ones

 

There are no way to know your HIV states unless you go for a HIV Test.

 

 

 

You Might Also Be Interested In:

HIV Test Singapore

Anonymous HIV Testing

STD Testing

STD Test Singapore

WORLD AIDS DAY 2020

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On December 1st, the global community unites to commemorate World AIDS Day, showing support for those living with and affected by HIV, and to remember those who have lost their lives to AIDS. This year in particular, the COVID-19 pandemic has laid bare how critically interlinked our health is with issues such as social inequality, human rights, stigma and discrimination, economic security, and political will and stability.

The theme of World AIDS Day this year is “Global solidarity, shared responsibility”. The COVID-19 crisis has demonstrated that, during a pandemic, no one is safe until everyone is safe. We all have a part to play in addressing the dual pandemics of COVID-19 and HIV/AIDS, in order to successfully eliminate them both as a public health threat.

There were approximately 38 million people living with HIV/AIDS in 2019, with an estimated 1.7 million people acquiring HIV in the year, marking a 23% decrease in new HIV infections since 2010. In Singapore, latest figures released in June this year showed 323 new cases of HIV infection reported among residents in 2019, bringing the total number of HIV-infected residents to 8,618 as of end of 2019, of whom 2,097 had passed away. The annual incidence of new infections locally has decreased overall by about 25% when compared to 2007 to 2017.

This decrease of new HIV infections is a result of the concerted and coordinated efforts of both government and community-led initiatives, but there is still much that can be done. In 2014, UNAIDS set an ambitious goal of eradicating the HIV epidemic by 2030. This involved a set of targets called the “90-90-90” vision, which stated that by 2020:

  • 90% of people living with HIV would know their diagnosis
  • 90% of those diagnosed with HIV would be on antiretroviral therapy (ART)
  • 90% of those on treatment would have achieved viral suppression

Singapore has made significant improvements towards the last two goals, with approximately 89% of people diagnosed with HIV on treatment and 94% of those achieving viral suppression; however, we are still relatively lacking in our progress towards the first target, with only an estimated 72% of people living with HIV who have been diagnosed. 

We know that early diagnosis leads to early treatment and better outcomes. Knowing their HIV status early will also help to prevent the spread of infection to others. Providing access to better information and testing for HIV, increasing awareness and uptake of Pre-Exposure Prophylaxis (PrEP), and ensuring long term compliance to antiretroviral therapy (ART) by people living with HIV are some of the primary facets of eradicating the HIV epidemic.

As we approach the end of a tumultuous year, the impact of COVID-19 has forced us to view our global health responses, including the HIV/AIDS response, in a different way. We must now be more committed than ever to ensure no individual or community is left behind – healthcare must be funded and accessible to all, stigma must be eliminated and vulnerable populations offered social protections, and public health systems must be strengthened through investment and sound government policy.

As the WHO has so accurately and succinctly captured:

“Now is the moment for bold leadership for equal societies, the right to health for all and a robust and equitable global recovery. This World AIDS Day, join us in calling on countries to step up their efforts to achieve healthier societies. This World AIDS Day let us demand global solidarity and shared responsibility.”

Tags: HIV Test Singapore, HIV Test, Anonymous HIV Testing

Just got diagnosed with HIV? What is next?

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You have just been recently diagnosed with HIV. You’re likely experiencing a rollercoaster of emotions and have lots of questions which are understandable. As you go through these feelings, whether of anger, fear, sadness or guilt, it is important to first take a deep breath and begin the process of finding a health care provider and as much as possible, look for any form of support available. 

Finding Support

 

1. Friends & Family

As you are coming to grips with the new diagnosis, you may face difficulty as to what the next step will be. You may want to talk about it with a trusted friend or family member. Although you may feel uncomfortable with breaking the news, you may realize that shouldering the burden alone actually makes it more difficult to process the news and that telling someone you trust may be a positive experience as it can help you get the much-needed support and it may actually strengthen relationships. It is important to be informed of the condition yourself – it may be best to obtain information about HIV before telling others about the new diagnosis. There are many myths that surround HIV which contribute to the stigma attached to it but by knowing more about living with HIV can reassure your loved ones that with effective medications available, you can live a long and healthy life.

2. Telling your partner

It is important to let your current or former partners know that they may have been exposed. They then should be tested for HIV. It is encouraging to know that many people living with HIV continue to have relationships and can have children who don’t have HIV. The term ‘undetectable = untransmittable’ (shortened to U=U) was coined and is used as a campaign to prevent sexual transmission of HIV without the use of condoms based on numerous studies that demonstrated this. This is achievable by taking treatment daily and having undetectable viral load levels for at least 6 months. However, until U=U is achieved, the proper use of condoms must be done to prevent transmission. In addition, your partner may also want to consider PrEP, in addition, to use of condom before you achieve undetectable viral loads for at least 6 months.

3. Clinics & Support Groups

As HIV is a chronic medical condition that requires lifelong follow-up and treatment, it is essential to establish a relationship with an HIV health care provider that is as honest and open as possible. You may either be managed at the clinic where the HIV diagnosis was made or referred to an HIV specialist and their team for HIV management. 

Among other tests, the key ones that will be done at the first clinic visit as well as during subsequent visits are HIV viral load as well as CD4 counts. The HIV viral load is a measure of the amount of virus detectable in the blood and the CD4 count is the amount of CD4 cells, which are white blood cells that play an important role in the immune system. The goal for everyone living with HIV is to reach an undetectable HIV viral load as quickly as possible.

Many guidelines recommend that HIV treatment be started immediately after the diagnosis is made. This is because studies have shown that immediate treatment can lower the risk of long term effects on the immune system and reduce the risk of HIV transmission.  

There are many support groups available where you can be a part of, to obtain further information from or would simply like to reach out for a listening ear as you may not be ready to tell your friends or family about the new diagnosis.

Here is a list of support groups available in Singapore & Malaysia:

Action for AIDS (AFA) (Singapore)

Oogachaga (Singapore)

GayHealth.sg (Singapore)

PT Foundation (Malaysia)

CD4 Count VS Viral Load – What do you need to know?

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The Immune system is made up of a large network of cells that work together to combat infections. Helper T Lymphocytes are a particular type of immune cell that expresses a molecule called the Cluster Determinant 4 (CD4). Helper T lymphocytes are hence commonly known as CD4 cells. The Human Immunodeficiency Virus (HIV) selectively targets CD 4 cells and uses them as hosts for viral replication. As the virus replicates, it destroys its host cell as it releases new copies of the virus. Therefore, as the viral load (which is a measure of the amount of virus present in the body) increases and the host CD 4 cells will decrease. 

HIV Pro Viral DNA Test

HIV Infection

During the early stages of a HIV infection, viral replication occurs at a very fast rate at the expense of CD 4 host cells. A vicious cycle occurs, wherein an increase in HIV viral load attracts more CD4 cells which get infected and become hosts to further increase the viral load. Within the first few weeks of a HIV infection, the CD 4 count falls precipitously. Such a sharp fall in CD4 cells is the hallmark of a HIV infection. 

Upon diagnosis of HIV, it is crucial that the patient’s CD 4 and viral load are measured. The CD 4 count allows the medical team to determine the state of the immune system and plan the appropriate treatment. If the CD 4 count is below 200 units, the diagnosis of Acquired Immunodeficiency Syndrome (AIDS) is established. AIDS is a serious complication of HIV infection and can be fatal, therefore, if the patient is diagnosed with AIDS he/she requires immediate medical attention in a hospital.The viral load will give an indication of how fast the virus is replicating. Current medication used to treat HIV infection targets different parts of  viral replication and interfere in the process of new viruses being produced. Therefore, a fall in viral load after commencing medication is an indicator that the medication is working. 

People Living With HIV

For People Living with HIV (PLHIV), the main goal of therapy is to increase CD4 cell numbers and decrease the viral load to an undetectable level. Monitoring these 2 parameters will guide the treatment regime. In general viral load is measured 2 weeks after starting medications for HIV, then at 4 to 8 week intervals. The expected fall in viral load should be to approximately < 500 copies/ml by week 8 – 16 and < 50 copies /ml by week 16- 24. CD 4 recovery is slower, the first CD4 test is done 3 months after commencing treatment and every 6 months after. In general, a CD 4 count > 300 cell/uL with a low viral load is a good level to ensure that PLHIV does not encounter any opportunistic infections.

Also read: U=U: Science, Not Stigma

CD 4 and Viral load measurements are essential parameters in guiding the medical therapy for PLHIV. Regular check of these parameters ensure that PLHIV are able to maintain an active lifestyle and avoid any infections that may occur due to a lowered immunity.

HIV Screening Singapore

 
 
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Common Medical Conditions That Are Asymptomatic

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Signs and Symptoms are technical terms to describe the extent of disease in a patient. A sign is an effect of the disease that can be observed by another person or elicited through certain manoeuvres while a symptom is an effect that is experienced only by the patient. 

What does being asymptomatic mean?

Being “asymptomatic” is when the patient does have the disease but does not experience any effects of the disease. In this article, we will be discussing 5 diseases where patients are usually asymptomatic in the early stages of the disease but as the disease progresses, it adds an increased burden on the body leading to more pronounced signs and symptoms.

The 5 diseases were selected because while there is no way for patients to know if they have the disease early on due to the lack of symptoms these diseases can be easily detected during health screening with your General Practitioner. Therefore, we hope to highlight the importance of your health screening in allowing your doctor to detect these diseases early and prevent the disease from progressing to a more severe state.

So just before you brush off that health screening appointment because “I feel OK” , have a read to see the benefits or early detection and treatment.

5 Diseases where patients are asymptomatic

Human Immunodeficiency Virus (HIV)

What it is?

HIV infection is a disease in which the virus attacks specific cells (CD4) in the immune system and uses the cells to create more copies of the virus, killing the host cells in the process. In the early stages of HIV, the rate of CD 4 cell production can still cope with the loss from the viral infection, therefore patients are mostly asymptomatic.

Over time as the virus replication picks up pace, the CD 4 cell numbers dwindle and the immune system becomes less effective in responding to environmental insults such as bacterial or fungal infections. Major risk factors for HIV infection include, IV drug use, unprotected casual sex and anal intercourse.

How do you test for it?

Point of Care testing can be done at most clinics in Singapore, this involves taking a sample of blood from a finger prick and placing it into a test kit. Currently, the earliest you can be tested for HIV is 30 days after infection. Early treatment of HIV prevents the virus from replicating and thus prevents the disease from worsening and progressing to Acquired Immunodeficiency Syndrome (AIDS).
HIV Testing Singapore
Anonymous HIV Testing Singapore

Chlamydia

What it is?

Chlamydia is a common bacterial infection in both Men and Women. Infection is usually found in the genital tract but also in the rectum, throat and even eyes. Up to 70% of women and 50% of men are asymptomatic. Left untreated, the bacteria can replicate further to eventually lead to an inflammatory state in the pelvis. This results in severe discomfort and particularly in women the risk of infertility is especially raised if chlamydia is untreated.

How do you test for it?

Chalmydia Rapid testing can be carried out to detect the presence of Chalmydia within 24 hours. A sample is taken from the region, a vaginal swab for women and a urine sample for men, and a Polymerase Chain Reaction is used to detect any chlamydial genetic material. Treatment of chlamydia can be as simple as a single dose of antibiotics if detected at an early stage.
Rapid STD Testing Singapore

Chronic Illnesses

High cholesterol

What it is?

Cholesterol can be thought of in 2 forms, a high density form (HDL) and a low density form (LDL). HDL lowers the total cholesterol in the body while LDL increases it. An increase in cholesterol and triglycerides (both from fatty foods) results in plaques developing within your blood vessels (Atherosclerosis). As the plaques increase in size, blood flow to your vital organs like your heart and brain are compromised thus increases the risk of heart attacks and strokes.

How do you test for it?

A blood test usually done at your health screening enables your doctor to determine the cholesterol levels in your body. Not all elevated cholesterol has to be treated with  medications because changes in diet and lifestyle can also lower cholesterol in some cases. 

Hypertension

What it is?

Hypertension is when your blood pressure is persistently elevated, the normal blood pressure should be below 140 systolic and 90 diastolic. There are myriad of causes for elevated blood pressure including, high salt intake, stress or kidney disease.

However, many people have Essential hypertension, which is when the blood pressure is found to be elevated for no particular cause. Even though the cause may not be determined in most cases of hypertension, patients with an elevated blood pressure have a higher risk of strokes. This is because, the increased pressure in the blood adds additional strain to the blood vessels, eventually, the blood vessels become weaker and are more likely to break, resulting in a stroke.

How do you test for it?

The diagnosis of hypertension in an asymptomatic patient involves a Blood Pressure diary where the patient measures her blood pressure at the start and end of the day for 2 weeks. A persistently elevated blood pressure may prompt the doctor to start treatment, however there are also non-pharmacological means of lowering blood pressure.

Diabetes

What it is?

Diabetes, in particular Type 2 Diabetes, is a condition where the body is unable to regulate carbohydrate metabolism. This results in wide spread effects on the patient because sugar derived from carbohydrate metabolism is essential to many cellular activities in the body. Although patients are mostly asymptomatic in the early stages of the disease, patients can eventually have a variety of pathologies as the disease progresses such as loss of sensation in the hands and feet, poor wound healing, reduced immunity and even blindness.

How do you test for it?

Testing for diabetes also involves a blood test to measure the sugar levels in a fasting state to gauge the current level of sugar metabolism in your body and the Haemoglobin A1c (HbA1c) which is a gauge of the long term extent of sugar metabolism in your body. Depending on the extent of your disease, treatment of diabetes can range of lifestyle modification to injectable medications.

Having a disease in its early stages sometimes means that you still feel “fine” and not experience any symptoms. However, if left untreated, these diseases can progress and lead to severe complications in your health. Getting checked regularly is essential for detecting disease in the asymptomatic phase and treating it early. This prevents the disease from progressing to a more severe state and allows us to lead better, healthier lives. Speak to your doctor today!

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Other Asymptomatic Medical Conditions:

Also on this site: Wart Removal Singapore, STD Check Singapore

Why you should not be embarrassed to get tested for HIV

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Many people are still not getting regularly tested for HIV.

In my line of work as a Family Physician, I frequently assist patients in performing Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infection (STI) screening. I would like to share a story of a patient I recently treated. 

40-year-old Melvin (not his real name) came by one day for a clinic consultation. His friendly and cheerful demeanour was accompanied with a mild level of anxiety. He shared with me his background: he was a gay man, in a monogamous relationship with a long term partner. Like many people, he had had several previous partners – past relationships, and the occasional casual fling. However, he had never undergone any screening tests to evaluate his sexual health. The last time he had been tested for HIV was over 20 years ago, when he enlisted for National Service.

“The honest truth is I am embarrassed and also fearful of seeing a doctor to do these tests. In fact, it took me a lot of courage to come to visit you today!”, said Melvin rather sheepishly.

“I have always had this avoidance mentality towards HIV. I felt that I would rather not get tested, and just live my life more peacefully. And really, what are the chances? I have always used condoms and compared to other people, I don’t think I have had many sex partners in my life,” he added.

He lets on further that it was after a lot of encouragement from his partner that he decided to bite the bullet and visit a clinic.

The news came as a complete shock to him – he had unfortunately tested positive for HIV. It took some time for him to come to terms with the result, and the fact that his life was never going to be exactly the same again. The silver lining was that Melvin was still in the early stages of the infection. He has since promptly started on treatment and is doing regular follow-up monitoring of his condition. The good news is that by doing so, he will likely be able to keep the virus in check and thus maintain a healthy immune system. 

Melvin’s case highlights a perennial problem in mankind’s fight against HIV. Despite continuous  efforts by health organisations to educate the public on HIV and increase awareness on the importance of regular screening, many people are still not getting regularly tested for HIV. It is estimated that 15% (1 in 7) of people in the United States are presently living with HIV and unaware that they have the infection. In an update on the HIV situation in Singapore earlier this year, the Ministry of Health (MOH) stated that only 14% of newly reported HIV cases in 2018 were detected by self-initiated, or voluntary, screening.

Common reasons that deter people from getting tested for HIV

1. I am scared of getting tested positive for HIV

Fear and anxiety are probably the biggest reasons why people avoid getting tested. The truth is, living in the unknown is worse and often scarier. It is far better to get the testing over and done with. If it is negative, it will bring much relief. If unfortunately the result is positive, all is not lost. Knowing your status early is the first step to getting support and receiving treatment in order to stay healthy. 

2. If I test positive for HIV, people will find out

Medical clinics and testing centres endeavour to keep all patient records strictly confidential. Under the Infectious Diseases Act in Singapore, a positive test for HIV is notifiable to the Ministry of Health (MOH). This is mainly for public health purposes, such as disease surveillance, monitoring the HIV infection situation, conducting contact tracing and assessing disease prevention and management measures. Healthcare professionals and MOH do not inform the patient’s employer, insurance provider and certainly not family and loved ones.

3. I am afraid of being judged or being embarrassed 

Healthcare professionals are trained to provide professional and non-judgmental consultation. If you do not wish to visit your regular doctor, take some time to do a search online as there are plenty of alternative options that you can consider. It is important to find a sexual health clinic or testing centre that you feel comfortable with. 

4. I trust my partner

If two HIV-negative people are in a monogamous relationship, then certainly there is no risk of HIV, but we are all human and no one is perfect. If one member slips up outside of the relationship, then both parties could be at risk of HIV, especially if engaging in unprotected sex. It is important to have open and honest communication with your partner. If you or your partner has had sex with any casual partner, or if there is any doubt about your HIV status, then do get tested.

5. I am not at risk of HIV

Even if you think that there is no chance that you have been exposed to HIV, as long as you are sexually active, it is recommended to do HIV testing at least once a year, or more frequently if your behaviour puts you at higher risk.

6. Who should test for HIV?

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 routine health care. 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.

Also read: HIV SYMPTOMS – WHAT YOU NEED TO KNOW

If you answer ‘yes’ to any of the questions below, you should get an 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 an 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 for 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 three types of HIV tests available. 

1. Nucleic Acid Test (NAT) 

Also known as an 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 a negative NAT result. Taking pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) may also reduce the accuracy of NAT. (All our clinics provide HIV PrEP & PEP services.)

A 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 in 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. 

What does the test involve?

In the clinic setting, all the tests are typically performed using blood samples. Laboratory testing can be performed for all three types of HIV tests, whereby blood is drawn from a vein and collected in a tube. Rapid testing is available for only the fourth-generation test and the antibody test, whereby a few drops of blood are obtained via finger prick, and the results are ready in 20 minutes. 

The rapid HIV antibody test can also be performed using oral fluids collected from the mouth and gums with a swab stick. Similarly, the results are ready in 20 minutes. This option is available in some clinics and community testing programs, such as Action for AIDS (AFA) Singapore. 

HIV Screening Singapore

Regardless of the test you choose, the process is simple and fuss-free, and no prior preparation is required – all you need to do is show up at the clinic. Pre and post-test counselling is always conducted professionally and non-judgmentally. 

Despite all this, there are many who still feel extremely self-cautious about approaching a doctor to discuss HIV testing, for fear of stigma and discrimination. This is where Anonymous HIV Test (AHT) comes in. AHT is offered as a means to encourage more individuals who suspect they might be at higher risk to step forward to do testing. There are only 10 clinics in Singapore that are licensed to offer AHT. AHT does not require any name, contact number or form of identification. Instead, a number is usually assigned to the patient for the purposes of providing the result later on. The patient is then required to fill up an anonymous questionnaire to provide some information on his/her sexual behaviour. When seeing the healthcare provider, he/she may be asked some further questions before undergoing the test. AHT is performed using rapid testing only. The entire process throughout is kept confidential and strictly anonymous, even if the test result is positive.  

Anonymous HIV Testing is available in our Robertson Walk Branch only.

What happens after the test?

If your healthcare provider uses a fourth-generation antigen/antibody test, you should get tested again 45 days after your most recent exposure. For other tests, you should test again at least 90 days after your most recent exposure to tell for sure if you have HIV.

If your last HIV test was negative, you can only be sure you are still negative if you have not had a potential HIV exposure since then. If you are sexually active, continue to take actions to prevent HIV, like using condoms the right way every time you have sex and taking PrEP if you are at high risk.

Please get tested if you have not done so recently!

The worst part about the prospect of HIV and/or AIDS is living in the unknown. Do not avoid getting tested simply out of fear. Understanding your health and having a solid plan to stay on top of it – regardless if you are HIV-positive or negative – is the best way to live a long and healthy life.

Next read: HIV WINDOW PERIOD – TIMELINES FOR ACCURATE HIV TESTING

 
 
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艾滋病 (HIV) 的症状与治疗方法

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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

U=U: Science, not Stigma – This year’s Singapore HIV Congress 2019 theme

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“U=U: Science, not Stigma” is this year’s Singapore HIV Congress 2019 theme. The congress highlighted the ever-growing body of evidence supporting HIV testing, treatment and prevention, and on the ways in which science and stigma intersect. DTAP (Dr. Tan and Partners) clinic is proud to be part of the Singapore HIV Congress 2019 and continuously provides support to help end the transmission of HIV in Singapore by 2030 though our support of the Community Blueprint.

What is the Community Blueprint? Find out more: U=U: Science, Not Stigma

Dr. Jonathan Ti is a GP at DTAP @ Robertson clinic. He has a special interest in sexual health and HIV, and is a co-author of the Community Blueprint to End HIV-transmission and AIDS in Singapore by 2030, and part of the National PrEP Taskforce.

Rectal Douching and Associated Infection Risks

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Similar to vaginal douching, rectal douching or anal douching is not something that many people talk about it polite circles. It is commonly practiced by Men-Who-Have-Sex-With-Men (MSM) who receive anal sex. Let’s face it, generally we don’t want our loved ones to have to deal with our faeces while having anal sex. However there is a growing concern about the practice of performing anal douching and its associated risk of STI including HIV infection.
Other Read: Anal Pap Smear for Anal Cancer.

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A recently published systematic review (essentially this means that the study involves gathering all published studies on a subject and compiling the findings together) in the journal Sexually Transmitted Infections (May 2019), there is evidence to suggest that anal douching can potentially increase the risk of STI and HIV infection among MSM. In the systematic review, it included a total of 28 studies looking at anal douching and the risk of STI/ HIV in MSM population around the world (46% from US, 35% from Europe and the rest from South America, Asia and Africa). 
Also Read: STD Risk From Receptive Unprotected Anal Sex In Men

The findings show that men who perform anal douching compared to those who don’t have a 2.8 times higher risk of HIV and close to 2.5 times higher risk of any other types of STIs (Hepatitis B, Hepatitis C, chlamydia, gonorrhoea, syphilis and HPV). With respect to specific STIs, the study found that anal douching increases the risk of chlamydia and gonorrhoea by up to 3.25 times and 3.29 times for Hepatitis B Virus and Hepatitis C Virus.
It is theorised that possible reasons for the association of anal douching with increased risk of STIs and HIV may be due to:

  1. Water and/ or soap causes the delicate lining of the rectum and intestines to become damaged.
  2. Removal of normal flora (bacteria that normally is found in the rectum) due to the action of flushing
  3. Risk of transmission of STIs and HIV through the sharing of douching devices much sharing of needles for IVDU. 

 

The authors also noted that further studies will be needed to further elucidate this association between anal douching and STIs and HIV infection.
Speak to your doctor if you have any questions regarding the associated infection risks from rectal douching or anal douching.

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HIV Elite Controllers and Long-term Non-progressors

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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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