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WORLD AIDS DAY 2020

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.”

Just got diagnosed with HIV? What is next?

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)

This article is written by Dr. Ezlyn Izharuddin. Dr Ezlyn has experience in HIV Treatment and Management, as well as other Infectious Diseases management.


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

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


Common Medical Conditions That Are Asymptomatic

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!


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

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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Staying at home but still having a fever?

What Tests Can I Do For My Fever?

A DTAP Stay Home Series Part 3

We touched on the COVID19 situation and the active steps one can take to minimize and prevent infection risks on our past two articles.

Furthermore in our last article we also delved deeper into some of the situations one may face whilst at home, running out of needed medications or even repeated sneezing and scaring away every around. 

But wait, I don’t need further medications, I don’t need to get my sneezing checked but I have this fever which I am worried about. What should I do doc? 

Fever is one of the classic symptoms of one’s body responding to an infection. It is a signal that the immune system is reacting to a foreign invader. These foreign invaders can be anything from the seasonal Influenza Viruses, upper respiratory tract bacterial infections, Dengue fever, the dreaded COVID19 virus or even worse, the most feared HIV virus.

Before we get carried away, let’s explore the facts behind each of these concerns and hopefully we can provide you a handle on how to get these concerns further addressed. From the recapitulation of COVID19, to upper respiratory tract infections and last but not least prolonged fever from possible HIV. 

COVID 19 

Let’s start with a short recap of COVID 19, from the WHO-China joint COVID 19 mission, it was studied that those who are at great risk of severe disease and death include those above 60, those with underlying chronic conditions. And of course as previously discussed, the risks of COVID19 include travel to at risk countries including China, especially Wuhan and Hubei provinces, South Korea, Iran and Northern Italy as of March 2020.

Practically the same advice shared previously of personal hygiene and avoidance of crowded places and even ordering in the medications you need delivered to your home would still stand.

Also read: STAYING AT HOME AND ORDERING IN (A PIZZA) YOUR MEDICATIONS

Upper Respiratory Tract Infections 

Secondly if it were an upper respiratory tract infection caused by other viruses or bacteria, it would be good to have your doctor assess you especially if there are symptoms of fever, cough, sore throat or runny nose. In the current climate, these symptoms would warrant one to get extended rest at home with a doctor’s note (medical certificate) for at least 5 days. When we get an infection in the upper respiratory tract – nasal passages or throat, it is usually caused by either a bacteria or virus.

SYMPTOMS OF A COLD

A cold is a viral infection of our respiratory tract, and there are more than 200 types of viruses which can cause this. It is also a gradual Onset.

SYMPTOMS OF FLU

Sudden onset. Contagious after coming into contact with droplets. The FLU virus can cause a lung infection called pneumonia.

So doc, i’ve heard alot about antibiotics as well, can I just get them prescribed to me for my fever?

Antibiotics however only work against bacteria infections.

Instead of taking too many unnecessary medications, you can get tested to see if you have the flu or a bacterial infection.

Point of care testing is convenient, accurate and gives you an answer in 15mins. Furthermore for those at risk or diagnosed with Influenza (above 60 or have chronic diseases) – antivirals can be prescribed. These include XOFLUZA (a one off treatment) or TAMIFLU and lastly if it is likely a cold, vitamin C and zinc are shown to aid in recovery.

And last but not least, especially for those at risk, please do not forget your twice yearly flu vaccinations (Northern and Southern hemisphere strains respectively) and 2 different jabs for a lifetime protection against Pneumonia.


Fever from HIV

But that being said, what happens then if one’s fever is still persistent and there were concerns from a recent sexual exposure? Especially if it was a causal partner and or someone you met overseas?

The CDC page tells us that HIV is spread when anal or vaginal sex, without a condom occurs with someone who has HIV. The other way HIV is spread is through the sharing of needles or syringes, or even equipment used to prepare drugs for injection with someone who has HIV. Some studies have shown that HIV can survive in a used needle for up to 42 days depending on environmental factors. Temperature etc.

In rarer cases, HIV can be spread through oral sex.

The main transmission medium of HIV however is through fluids and these are predominantly blood, vaginal fluid, semen and even saliva. Here are some statistics from medical studies that have been done. And as you can see, needle sharing, needle use has the highest risk followed by anal intercourse.

Ultimately all these statistics mean nothing, if the concern is still there and there is an exposure, the best thing to do for an ease of mind would be to speak to your doctors and decide whether the Rapid HIV test is something necessary for you.

In summary, there are many causes of fever. In the current climate, fever persisting for more than 5 days can be worrisome. And common things being common, in the absence of a travel history, it is most likely due to an upper respiratory tract infection arising from a cold, influenza or even bacteria. The likelihood of COVID19 is low, but one must also keep a suspicion for infections such as dengue and in the rarest of events HIV. Seeing a doctor early would help you get some point of care tests done with results almost immediately to guide your clinical care and most importantly give you a peace of mind.

Take care, stay safe.


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  • References
  • Boily MC et al. Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. Lancet Infect Dis 9(2): 118-129, 2009
  • Vittinghoff E et al. Per-contact risk of human immunodeficiency virus transmission between male sexual partners. American Journal of Epidemiology 150: 306-311, 1999
  • Del Romero J et al. Evaluating the risk of HIV transmission through unprotected orogenital sex. AIDS 16(9): 1296-1297, 2002
  • Townsend C et al. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006. AIDS 22: 973-981, 2008
  • Baggaley RF et al. Risk of HIV-1 transmission for parenteral exposure and blood transfusion. AIDS 20: 805-812, 2006


ZIKA IS AN STD!! – Battling the STD Stigma

The Zika virus gained notoriety in Brazil when it was blamed for causing a spate of birth defects known as microcephaly. Babies born with microcephaly had abnormally small heads and often also suffered concurrent problems with brain development. Some children born to Zika infected mothers had normal sized heads but their heads would fail to develop normally. These are obviously horrible consequences for both the mother and child. 


Zika is a virus that is spread by mosquitoes very much like Dengue. However, it was soon discovered that Zika was also sexually transmitted. And that consistent and correct use of condoms protected pregnant women from the Zika virus and consequently their unborn children to the devastating effects of Congenital Zika Syndrome.  

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But wait a minute? Does that mean Zika is an STD? Technically it seems to fit. STD is an acronym for Sexually Transmitted Disease. Zika is a disease that is sexually transmitted. But it is predominantly transmitted via the bite from an infected mosquito. So is it an STD? If Zika is an STD then is raises other uncomfortable questions like: if a person catches chickenpox from his/her partner because they had sex, is chickenpox then an STD too? Or even the common Flu, which is spread as an airborne virus, can also easily be caught via sexual intercourse. So the common Flu is an STD!


I’ve had this discussion many times with my patients when they have been diagnosed with an infection and they ask me “is it an STD?” Sometimes, this is rather easy to answer. If they have, for example, an infection of Gonorrhoea of the penis, one can be confident to say that they caught it from a sexual contact. But at times, things get murky. A good example is an infection with Ureaplasma Urealyticum. We know this tiny bacteria can be sexually transmitted. We also know that it can seem to appear out of nowhere in mutually monogamous couples. We also know that it can be just a commensal and not a disease causing pathogen. So when a patient with an infection of his urinary tract caused by Ureaplasma asks me “is this an STD?” I am unable to give a direct black and white answer. 


The same goes for what I would describe as the most feared STD by many, and that is HIV. For a fact, the commonest way that HIV is transmitted is via sexual contact. However, we also know for a fact that HIV can be transmitted by sharing needles, contaminated surgical instruments, transfusion of contaminated blood and transplant of contaminated organs. Albeit the last 2 hardly happens anymore due to increased awareness, better infection screening protocols and technology advancement. But let’s be honest, if and when we find out someone is infected with HIV, getting injured by surgical instruments is not likely the first reason to pop into our heads.


And therein lies the issue. Answering the question “is this an STD?” does not in any way contribute to the clinical management of the disease except perhaps for contact tracing. For partner protection, the same advice will be given if the disease can be transmitted sexually regardless of whether or not it is called an “STD”. The issue, I believe, is stigma. To be labelled as having an “STD” is to be labelled as a moral or sexual deviant. But should this really be the case? Infections are caused by microorganisms invading our bodies and using our resources to make more of themselves. Drawing on resources around them to reproduce is hardcoded into the genetic material of all living things, humans being the best and worst examples. Microorganisms do not care how they are transmitted or where they infect as long as the environment they are in supports their reproduction. Microorganisms do not care about our textbooks and whether or not we call them STDs.


Consequently, some infections although predominantly transmitted by sex, can also be transmitted by other means. And some that can easily be caught via sex, are for some reason not given the label “STD”. I do hope we can eventually drop this label and treat infections for what they are – infections. Treat the patient, prevent reinfection, protect partners. Labels are useless. 

Next read: WHAT IS ANTIBIOTIC RESISTANT GONORRHEA OR SUPER GONORRHEA?

Speak to your doctor for more information or if you have any questions regarding Dengue Rapid Testing or other Dengue related topics: Dengue in the era of COVID, Dengue Fever Symptoms? Dengue Fever What You Need to Know, Why the recent resurgence in Dengue Fever?, ZIKA IS AN STD!! – Battling the STD Stigma


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People Living With HIV In Singapore

The alarm chimes to life. As the incessant ringing crescendos the clock face starts to flash an LED blue. Mr. J stretches a slim arm out from under the blankets and pushes down on the snooze button. It was 6:00am on another nice balmy morning in Singapore. Because it was approaching the year end it was a cool 24°C. Jumping out of bed, Mr. J prepares for his morning run on the Park Connector, a network of roads and paths linking the various parks and gardens in Singapore.
A quick shower follows his run and he slips into his shite cotton shirt and blue cotton pants, all ready for a 20 minutes ride on the MRT to Raffles Place and his office in the financial hub of Singapore. After a hard day’s work a 10 minute walk takes him to Fullerton One where he enjoys a well earned dinner and drinks with his friends while the sun sets behind the Marina Bay Sands integrated resort. Another most typical day for a typical Singaporean in Singapore. Except for one difference. Mr. J is one of the almost 7000 people living with HIV in Singapore. 
I set up our first clinic at Robertson Walk in 2005 and in 2008 was awarded the mandate to conduct anonymous HIV tests. Mr. J saw me in 2009. He was recently married. His wife had to spend a few days out of town and he saw no harm in engaging the services of a sex worker. He did not use a condom. As the positive line slowly materialized on the test strip, I turned to Mr. J and said “It looks like the test is positive.”
He screamed and he screamed. He could not stop screaming. He grabbed the pillow on my examination couch and screamed into that. Even in the state he was in, he was considerate enough not to scare the other patients in the waiting room. He finally picked up his phone and called his brother. Soon after, his mother and his brother arrived. They spoke and they cried. I told him it was going to be OK but I knew nothing I said was getting through. A few days later Mr. J came back to the clinic, this time with his wife. She tested negative. She had forgiven him and they were going to have a family together. He would be strong, he would take his medicines and he would live what I promised was a long healthy and meaningful life. 


Since 2008 our clinic at Robertson Walk has conducted more than thirty thousand anonymous HIV tests. We have given good news most of the time and bad news more often than we would like. We have diagnosed people from all walks of life, all orientations, all genders, all vocations and a huge variety of nationalities with HIV. It is a virus that does not discriminate. Some took the news with stoic calm, some crumbled mentally, emotionally and physically. We tell everyone the same thing: it is going to be OK. HIV is not a death sentence. HIV is a chronic disease. It is no different from diabetes. You just have to take a single pill a day. You just have to see the doctor a couple of times a year. It is not so bad. It is not so bad. It is not so bad. It is going to be OK. We have held hands, wiped tears and held people together as they mended. 
After the initial shock comes acceptance and the relatively mundane work of getting the virus under control. We walk with them every step of the way from their first blood tests to their first pills. We link them up with emotional support services, we counsel them on their medical finances and step by step, piece by piece their lives reassemble and are made whole again.


On the 1st of April 2015, Singapore lifted its travel ban on people living with HIV. We opened our arms to all in the region who wished for our brand of care. We started seeing people living with HIV come from Malaysia, Vietnam, Indonesia and many other countries in the region. We provided the best care we knew how and watched like a proud parent as their viral loads dropped and the CD4 counts rose. 
2 to 3 out of every 1000 people in Singapore is living with HIV. Did you walk past a thousand people today? On the bus, on the train, in the mall, at your office? Then you have walked past a few people living with HIV. They are no different from anyone else. In fact, I often tell my patients that the people living with HIV I know are frequently in much better shape. Perhaps they appreciate their health more. It is also a myth that once a person is diagnosed with HIV in Singapore the authorities will come flying in and inform his family and his employer and every time he goes past immigration the officers will look at their screens and give him a dirty knowing look.
None of these happens. In fact, laws in Singapore protect the anonymity of people living with HIV and punish people who share someone’s status unnecessarily. Another myth is that HIV treatment in Singapore is unaffordable costing thousands of dollars a month. There are now many schemes in place to make treatment extremely affordable. What still needs a lot of work is the stigma and discrimination. That is why almost every person living with HIV in Singapore keeps their status a secret. That is also why we salute Mr. Avin Tan who went public with his HIV status and now works tirelessly to help others.


The theme of this year’s World AIDS Day is “Communities make the difference. Communities are the lifeblood of an effective AIDS response and an important pillar of support.” Because HIV/AIDS is not “their problem”, it is our problem. Less stigma means a lower barrier to testing which leads to earlier diagnosis and decreasing the risk to others. Less discrimination means more willingness to seek help and treatment which leads to earlier viral load control and less contagion. More support means people living with HIV staying on treatment and remaining physically, mentally and emotionally healthy and contributing to society.


READ: WORLD AIDS DAY PRESS STATEMENT

My Facebook just got updated. There’s a picture of Mr. J with his wife and 2 lovely twin daughters at the Singapore Barrage. They look like they are flying kites or at least trying to. His girls must be 6 years old by now. 6 years since I tested both of them to be negative for HIV. They look like a really happy family. A typical Singaporean family.
Speak to your doctor if you have any questions regarding HIV, Anonymous HIV Testing, HIV Screening and HIV Treatment & Management.


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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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