HIV Symptoms, Causes and Prevention in Singapore
by: Dr. Paul Chang, General Practitioner, Regis Medical
Human Immunodeficiency Virus (HIV), or (Acquired Immunodeficiency Syndrome) AIDS are probably the most commonly known sexually transmitted infections (STI). In Singapore, approximately 200-400 new HIV cases are diagnosed annually.
What is HIV?
HIV refers to a virus that attacks the cells that help your body fight infection, leaving your body vulnerable to other infections and diseases.
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How is HIV transmitted?
HIV is a STI, which means that it is most commonly spread from one person to another during sexual intercourse. This is due to contact with bodily fluids of someone infected with HIV. HIV can also be spread through sharing injection drug equipment.
Is HIV the same as AIDS?
AIDS refers to the final stage of HIV, where the damage done to your immune system as a result of the infection has severely weakened your immune system. This exposes you to opportunistic infections or opportunistic cancers, which are diseases that would not cause illness in a person with a healthy immune system. HIV typically takes 8 to 10 years to fully progress into AIDS, if left untreated. Fortunately, with the progression of medicine and technology, the progress of HIV can be prevented via HIV treatment.
Symptoms of HIV
It is difficult to determine whether someone has HIV solely based on their symptoms. For most, they will exhibit flu-like symptoms within 2 to 4 weeks after infection. These symptoms may include:
- Fatigue
- Weight loss
- Prolonged fever
- Night sweats
- Skin rash
- Diarrhoea
However, these symptoms can also be caused by other illnesses. In addition, some people do not experience any symptoms despite being infected with HIV. This means that the only way to know whether you have HIV is via HIV testing.
Causes and Risk Factors of HIV
HIV is caused by a virus that is can be spread via:
- Sexual contact
- Sharing of drug injecting needles
- Contact with infected blood
- From mother to child during pregnancy, childbirth or breastfeeding.
Anyone can be infected with HIV. However, you will be at a higher risk of HIV if you:
- Do not use a condom during intercourse. A condom provides protection against STIs, which can lower your risk of getting infected. Unprotected anal sex is also riskier in comparison to unprotected vaginal sex.
- Have multiple sexual partners.
- Have an STI.
- Use shared needles and syringes.
Complications of HIV
HIV greatly weakens your immune system, leaving you vulnerable to many infections and certain types of cancers.
Infections common to HIV/AIDS
- Pneumocystis pneumonia (PCP), a serious fungal infection that lives in the lungs.
- Candidiasis, a common HIV-related fungal infection. While this infection usually occurs on the skin, it can sometimes enter the body and the organs, causing serious health problems.
- Tuberculosis, a potentially fatal bacterial infection. It is the leading cause of death among people with AIDS.
- Cytomegalovirus, a common herpes virus that can damage your eyes, digestive tract, lungs or other organs.
- Cryptococcal meningitis, an inflammation of the membranes and fluid surrounding your brain and spinal cord.
- Toxoplasmosis, a potentially fatal parasitic infection that can cause heart disease and seizures.
Cancers common to HIV/AIDS
- Lymphoma, a cancer that starts in the white blood cells.
- Kaposi’s sarcoma, a tumour of the blood vessel walls.
- HPV-related cancers, caused by human papillomavirus (HPV) infection, including anal, oral and cervical cancer.
Other complications
- Wasting syndrome, a condition in which weight loss is experienced along with diarrhoea, chronic weakness and fever.
- Neurological complications. HIV can lead to neurocognitive disorders ranging from mild to severe. This may include behavioural changes, reduced mental functioning and even severe dementia.
- Kidney disease. HIV can lead to an inflammation of the tiny filters in your kidneys.
- Liver disease. Liver disease is another sever complication of HIV, particularly in people who have hepatitis B or hepatitis C.
Diagnosing HIV
HIV can be diagnosed via a range of STD tests, including:
- Antigen/antibody tests, such as the HIV 4TH Generation Rapid Test, which involve drawing blood from a vein. These tests look for antigens on the HIV virus or antibodies produced by your immune system when exposed to HIV.
- Antibody tests, which look for antibodies to HIV in your blood or saliva. These can include rapid HIV tests, including self-tests that can be done at home.
- Nucleic acid tests, which searches for the virus in your blood.
It is recommended that you get tested if you:
- Have engaged in sexually risky behaviour
- Are unsure of your partner’s sexual history
- Have a change in sexual partner
- Had yourself pierced or tattooed at an unhygienic or unlicensed parlour, or if you have shared needles or sharps
- Have had a blood transfusion or operation overseas, where blood testing regulatory requirements may not be as strict
- Feel at risk of a STI
For those engaging in sexually risky behaviour, it is ideal to get tested more frequently, even up to every 3-6 months.. Getting tested will allow you to seek treatment early and prevent others from getting infected if you are diagnosed with HIV.
If you are diagnosed with HIV, a specialist can help to assess if you require additional testing to determine the stage of your disease and appropriate treatment. Tests may include:
- CD4 T cell count. CD4 T cells are white blood cells that are destroyed by HIV. Even without symptoms, HIV infection will progress to AIDS when your CD4 T cell count falls below 200.
- Viral load. This test checks for the amount of viral load in your body. HIV treatment will aim to lower your viral load, to an undetectable level if possible.
- Drug resistance. Certain strains of HIV may be resistant to medication. This may affect your treatment options.
Preventing HIV
There are some ways to lower your risk of getting HIV. These include:
- Abstinence
- Using a condom during sex
- Taking PrEP (pre-exposure prophylaxis) prior to sexual intercourse
- Regular testing for STIs
- Taking PEP (post-exposure prophylaxis) after a possible exposure
PrEP
PrEP is a medicine that reduces your risk of getting HIV from sex or injection drug use. Strict medication adherence will make the drug highly effective in protecting against HIV. You must be HIV and Hepatitis B negative before you can start PrEP. This would entail doing an official test with a licensed medical provider, and NOT self-test kits bought online. This also means that you should not engage in unprotected sex during the window period before your official test. i.e., if you are doing a 4th generation HIV test before starting PrEP, please ensure that you do not engage in unprotected sex 1 month before this test. After starting PrEP, please continue to undergo regular sexual health screenings and monitor kidney and liver function at least once a year.
PrEP medication can also have side effects such as possible damage to your kidneys. This means that you will need to undergo certain tests before and while taking PrEP. Do note that PrEP requires a doctor’s prescription.
PEP
PEP is a type of treatment started immediately after a possible HIV exposure to prevent infection. PEP should be initiated within 72 hours of exposure to ensure effectiveness. Side effects of PEP include nausea and diarrhoea. Your renal and liver function also must be closely monitored before and whilst you are on the medication. PEP is not the same regimen as PrEP. Do note that PEP requires a doctor’s prescription.
Can HIV be cured?
No, unfortunately there is no cure for HIV. However, HIV treatment can prevent the disease from progressing and suppress it to levels where it cannot be transmitted.
HIV Treatment
Antiretroviral Therapy (ART)
If you are diagnosed with HIV, regardless of your stage of infection or complications, ART is heavily recommended. ART is the most effective method when it comes to reducing the amount of HIV in your blood. Treatment will involve combinations of drugs that will:
- Account for individual drug resistance
- Avoid creating new drug-resistant strains of HIV
- Maximise suppression of HIV virus in the blood
Staying on effective ART treatment is the best way for HIV patients to remain healthy. An effective ART treatment will keep HIV viral load levels undetectable. To do this, you will have to ensure that you take the medications as prescribed, without missing or skipping any doses. This will help to:
- Keep your immune system strong
- Lower your risk of infections
- Lower your risk of developing HIV that is resistant to treatment
- Lower your risk of transmitting HIV to other people
You may want to discuss your condition and treatment with a trusted health care provider, to go through any possible side effects, difficulties you may have taking medications, and any mental health or substance use issues that may affect whether you can maintain ART. Regular follow-up appointments with your health care provider is also crucial, so that your condition and response to treatment can be monitored.
Living with HIV
While HIV is not curable, it can be effectively suppressed with effective ART treatment, meaning that HIV patients can live healthy, happy and productive lives just like anybody else. With effective ART treatment, HIV patients are no different from any other person living with a chronic disease such as diabetes, hypertension or high cholesterol. In addition, with successful ART treatment, people with HIV can engage in sexual intercourse without the risk of transmission, meaning that they can still have children just like anybody else. Do note that it is mandated by Singaporean law that you have to inform your partner regarding your status, and they will need to consent with the knowledge of the risk of transmission before engaging in any sexual intercourse. With increased knowledge and awareness regarding HIV/AIDS, the stigmatisation surrounding the disease can be reduced within society.
Consult a Doctor regarding your condition
If you suspect that you are at risk of HIV, it is crucial that you seek medical advice as soon as possible and undergo HIV screening. If you have already been diagnosed with HIV, it is important to continue consulting a trusted healthcare provider regularly to monitor your condition and treatment process.
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