A Comprehensive Guide to HIV & AIDS in Singapore

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HIV (Human Immunodeficiency Virus) belongs to a family of virus known as retrovirus, that attacks the body’s immune system. They use RNA instead of DNA to produce more copies of nucleic acid, thus giving rise to the term retro or “backward”. If HIV is not treated, it can lead to AIDS (Acquired Immunideficiency Syndrome). 

 

In this article, we cover frequently asked questions about HIV transmissions, symptoms, protection and screening.  

 

  1. How is HIV usually transmitted? What are some misconceptions about the transmission of HIV? Can it be transmitted through kissing?

 

 

HIV is typically transmitted via sexual contact or bodily fluids transfer such as blood and breast milk. It must come in contact with a mucous membrane or damaged tissue or be directly injected into the blood-stream.  

 

Tramissions of HIV does not occur with casual contact like kissing, holding hands, sharing toilet seats. It is also not spread by air or water, insects, including mosquitoes or ticks bites or saliva, tears, or sweat. There is no documented case of HIV being transmitted by spitting, another common misconception of HIV transmission. 

 

Some people may think due to some studies done in laboratories that HIV can survive outside the human body for days or even weeks. It is important to note that the concentrations used in laboratory studies are at a much higher level than what would normally be found in human bodies thus it is not a true reflection of the actual survival of HIV virus under normal environmental conditions. In fact, US CDC studies have shown that drying of high concentrations of HIV reduces the amount of infectious virus by 90 to 99 percent within several hours. 

 

  1. AIDS is the final stage of an HIV infection. Are there any other differences between HIV and AIDS?

 

When left untreated/uncontrolled, HIV leads to AIDS. During a HIV infection, the HIV virus is actively reproducing but usually does not cause any symptoms. As the infection progresses, it leads to AIDS where the immune system becomes badly damaged that complications and symptoms start to appear. 

 

 

  1. What are the symptoms of HIV/AIDS? Are there symptoms that are only specific to AIDS? 

 

Common HIV Symptoms 

 

Once infected with HIV, some people may develop the following symptoms but many others who are infected are asymptomatic, showing no symptoms at all.  

 

  • Fever 
  • Headache 
  • Malaise 
  • Enlarged lymph nodes (typically found around the neck, armpits, groin areas) 

 

As you can see from the list above, many other medical conditions such as the regular cold/flu or cancer can also have similar symptoms. 

It is important to note that HIV symptoms are non-specific (meaning they can be due to many other medical illnesses or conditions) and many do not develop symptoms after the initial infection. 

 

After the initial phase of HIV infection, the infected individual can remain asymptomatic (no symptoms) for up to 10 years. During this asymptomatic phase, the HIV virus is actively reproducing and killing the body’s immune cells. When HIV is not treated, the body’s immune system continues to weaken to the point where the infection progress to the stage of AIDS. 

 

Common AIDS Symptoms 

 

  • Persistently enlarged lymph nodes 
  • Lack of energy 
  • Weight loss and muscle wasting 
  • Frequent fevers and sweats 
  • Persistent or frequent yeast infections (oral or vaginal), sometimes even in the blood 
  • Persistent skin rashes or flaky skin 
  • Short-term memory loss 
  • One or more infections (opportunistic infections) related to having a diminished immune system, such as tuberculosis and certain types of pneumonia 

 

There are some conditions/ illness/ symptoms that are termed as AIDs-defining illnesses like, fungus infection of the esophagus, bronchi, trachea, or lungs, infection of the eye with a particular virus called cytomegelovirus (CMV) resulting in loss of vision, Karposi sacrcoma which is a type of cancer blood vessels or lymph vessels which manifest as dark lesions on the skin, wasting of the muscles and many others. 

 

  1. There is no cure for HIV, but anti-retroviral therapy can help to improve the immune system and suppress the virus in a patient’s system to undetectable levels. 

 

There is currently no cure for HIV. Medical professionals and scientists around the world have been working towards finding a cure. At present, the most effective treatment is antiretroviral medications.  

 

Typically the treatment of HIV requires a combination of different antiretroviral medication each targeting a particular part of the process in which HIV reproduces or enters the human cells. The reason for the multi-pronged approach is because the HIV virus can easily mutate as a result of the error-prone replication of the genetic material.  

 

An effective HIV treatment aims achieve undetectable viral loads. This means that using the most modern and sensitive machine, the number of virus in each ml of blood is less than 40 copies. In most cases, this is achievable provided that the medications are taken consistently every day for the rest of their lives and if the HIV virus does not develop resistance to the medications used in that particular patient.  

 

There are 5 main group of HIV medications, with each of these groups targeingt a specific stage of how HIV virus would infect and reproduce in  a human cell: 

 

  1. Nucleoside Reverse Transcriptase Inhibitors (NRTIs)  
  1. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) 
  1. Integrase Inhibitors 
  1. Protease Inhibitors (PIs) 
  1. Entry Inhibitors 

 

NRTIs and NNRTIs target a protein that is essential to the HIV virus when it tries to makes copies of its genetic material. By inhibiting that protein, the HIV cannot make copies of itself. 

 

Integrase Inhibitors work by inhibiting a protein required by the HIV virus to insert its genetic material into the human genetic material. 

 

Protease Inhibitors inhibit a protein that the HIV virus uses to cut up other proteins that it needs to exit the human cell so that the newly made virus can infect other human cells. 

 

Entry Inhibitors as the name suggests inhibit the HIV virus from being able to enter the human cell. 

 

HIV treatment typically requires a combination of the different groups in order to achieve effective suppression of the virus, usually a combination of medication from 3 different groups. 

 

In fact, many drug companies have started combining multiple HIV medications into a single pill thus patients nowadays would only need to take 1 tablet per day. This greatly influences the compliance of patients taking the medication. In the early days of HIV treatment, it is not uncommon for patient to multiple tablets multiple times a day.  

 

In the modern day treatment of HIV, most patients do very well in terms of keeping the virus in check and also side effects as well. In fact, the treatment of HIV nowadays is effective enough and has very little side effects that many patients may live a normal lifespan as someone who does not have HIV. They can continue to lead a productive life.  

 

 

  1. HIV can take up to 10 years to develop into AIDS without medical intervention. If left untreated, a person will usually die between 1.5 and 3 years after developing AIDS. Would it be as such correct to assume that if the infection has developed into AIDS, a patient’s chances of survival are significantly lower? 

 

In 2011, BMJ published a study that shows HIV positive patients who were diagnosed late or did not start therapy until later stage, live on average 13 years lesser than HIV positive patients who were started on therapy early or diagnosed early. In 2015, NEJM published a study involving a randomised trial involving multiple countries showed that deferred treatment of HIV positive patients is associated with higher risk of mortality and morbidity. In fact the trial ended prematurely as it became unethical to withhold treatment for the group that had delayed treatment when interim results showed a significant difference in mortality and morbidity. 

 

  1. HIV may be prevented if one takes Post-Exposure Prophylaxis (PEP) within 72 hours of being in contact with the virus. What are the chances of success with PEP? 

 

More accurately, PEP if taken prior to 72 hours after significant exposure and taken correctly greatly reduces the risk of developing HIV infection. Because of ethical issues, there is no randomised controlled blinded studies (which is currently considered as the best type of study to do), the available data on the effectiveness of PEP is based on other types of studies including perinatal clinical trials, observational studies of health care workers receiving prophylaxis after occupational exposures, and observational and case studies and animal studies shows that PEP can be as effective as 94-98%. 

 

PEP is available in Emergency Department restructured hospital in Singapore and they typically would give a 3 day supply with an appointment for the person to be seen in the outpatient clinic by an infectious disease doctor who will then reassess and given another 24 day supply of the medications. Most GP clinics in SIngapore do not offer PEP.  

 

PEP involves taking 2 types of medication – Truvada and Isentress (this is one of the drug regimens recommended by CDC and WHO). These are drugs taken by HIV positive patients as treatment as well. The recommended duration for PEP is 28 days, that is to say that the patient should be taking both medications daily for 28 days. 

 

  1. What are the stats on HIV in Singapore? Particularly on women and men in their 20s–what are the figures like here? 

 

According to MOH, there were 434 new cases of HIV in Singapore residents in the year of 2017. The rate of new HIV infections in Singapore residents has been relatively constant in the last decade hovering around 100 to 120 cases per million resident population in Singapore. Heterosexual transmission accounted for 36% of all cases, while 50% were from homosexual transmission and 10% from bisexual transmission in 2017. 94% of the new cases in 2017 were males. 

 

In 2017, there were 95 new cases of HIV infection in males in the age group of 20-29 while in females of the same age group, there were 7 new cases. It is evident that there is significantly more men who are newly diagnosed with HIV than females. This holds true for all age groups between male and females.  

 

  1. Are there any tips to protect ourselves against HIV? 

 

Practice safe sex: Consistent and correct condom use has been shown to be highly effective in reducing risk of HIV transmission. Use of the right lubricant with condom is also important, only water-based or silicone lubricants, not oil-based.  

 

You can visit this site for additional tips on use of condom and lubricants – http://www.aidsmap.com/How-to-use-condoms-and-lubricant/page/1322495/ 

 

Not having multiple sex partners: Numerous studies shown that having multiple sex partners increases the risk of HIV infection. 

 

Seek advice from your doctor if you believe that there is a chance that you have had a recent significant exposure to HIV especially if the exposure has been less than 72 hours, then you can discuss with your doctor about starting on PEP. 

 

  1. What should one do if they suspect they’ve been exposed to HIV? What usually happens in a screening test? Are these tests anonymous? Must one declare their condition if they’re HIV positive?

 

If you suspect that you have had an exposure, go to your nearest doctor and seek his/her advice for the following: 

 

  1. If there is a significant risk of exposure (for example unprotected vaginal sex/ anal sex, sexual contact with high risk group, condom breakage or slippage) 
  1. Whether you can start PEP especially if exposure is less than 72 hours ago 
  1. To do HIV screening test 

 

 

 

HIV screening test 

 

Generally, after understanding the circumstances of the exposure, the doctor will advise you on whether there is a need to perform an HIV screening test, and will also help determine which HIV screening test to perform (based on the number of days since the last exposure).  

 

The 4th Generation HIV tests looks for both antigen of the HIV virus and also antibodies to HIV and it is used in cases where the exposure was more than 28 days ago but less than 3 months ago. The 3rd Generation HIV test looks for antibodies to HIV. This test can be used if the exposure happened more than 90 days ago. 

 

The doctor will usually use a disposable tiny needle to prick your finger and 1-2 drops of blood will be put onto the test strip and a solution will be added to the test. After 10-20 minutes, the result will be available and the doctor will then explain the result to you. If there are more than 1 line in the test result, this suggests that the HIV screening test is positive and you may have been infected with HIV. If there is only 1 line in the result then the test is negative. 

 

If the HIV screening test is positive, the doctor will need to take blood but this time from your arm and send it to the laboratory for confirmation testing. Usually the confirmation test will take 1-2 weeks for the results to be available. 

 

In the past, there used to be HIV screening test that did not involve blood where a cotton bud is used to swab the inside of your cheeks. However this type of screening has fallen out of favor due to the fact that it is less sensitive than those tests using blood samples. 

 

Anonymous HIV testing in Singapore is only available in 10 clinics or centers as special permission from MOH is required before a clinic is allowed to offer anonymous HIV testing. Anonymous HIV testing means that you can go to the clinic and you just need to inform the clinic staff that you want to do anonymous HIV test and no further personal details will need to be recorded (that is to say you do not need to give your name/ IC number/ passport number/ address/ phone number). 

 

Once a person is confirmed to have HIV infection, it is a criminal offense under the Infectious Disease Act to not declare to your partner whom you are going to have sexual contact with about your HIV status. However, you are not obliged to inform your employer or other people if you choose not to. Having said that, certain employment do require you to inform them of any change to your HIV status as certain jobs would carry risk of transmission to your fellow workers or the general public.  

 

Boon Lay Clinic & Surgery 

Boon Lay Clinic & Surgery is a primary care clinic brand under Singapore Paincare Holdings Limited; the goal is to bring affordable medical treatments to the heartland areas. 

Led by Dr. Julian Ng, Boon Lay Clinic & Surgery provides chronic disease management, men’s health (men’s HIV & STD screening), women’s health, health screenings, vaccinations, corporate healthcare, medical examinations (maid/ employment permit/insurance/student pass). 

Address: 221 Boon Lay Place, #01-240 Singapore 640221 

Contact number: +65 6265 5247