HIV, 30 years on

In Thailand, the first Asian cases were reported in 1984 by a team from Chulalongkorn hospital. Third years on, the World Health Organisation (WHO) puts the number of deaths from the pandemic at about 36 million, with roughly the same number currently infected worldwide. 

Despite significant progress in early diagnosis and treatment, this infectious disease still represents major public health and economic issues especially in emerging nations. Thailand, which was once praised by international health organisations for its early and successful Aids awareness campaigns, has lost ground to the disease with worrying up-trends among young people and sex workers.

Aids is the full-blown manifestations of a chronic and contagious infection caused by the Human immunodeficiency virus (HIV). 

You can get HIV from sexual contamination by an infected person or from infected blood through sharing needles or through transfusion. Pregnant women can transmit the virus to their babies in the womb, during delivery and through breast-feeding. The virus is not passed on through casual contacts such as hugging, kissing or shaking hands. 

HIV infection evolves in 3 phases. The first, which presents after one or two months’ incubation, mimics a short-lived flu infection with high fever, headaches, cough and muscles ache. The second phase is a long “silent” period without symptoms that can last from two to 15 years (10 years is the average) during which the virus progressively and markedly weakens the immune system by destroying some specific white blood cells, the T lymphocytes of CD4 subtype. 

The third phase occurs when the CD4 count drops to a very low level. At this stage, the body’s defence system can no longer prevent common infections that very rarely affect healthy individuals. The depressed immune system also favours the development of certain cancers and damages multiple organs. 

HIV infection is now rapidly diagnosed with blood or saliva tests within a few weeks or months of contact with an infected individual. Contrary to the past wait-and-see attitude, treatment is today initiated the moment HIV is diagnosed, not least because it clearly provides benefits for both the patients (faster return to almost normal immune system) and their sex partners (90 per cent lower risk of sexual transmission). 

HIV therapy consists of 3 to 4 antiviral drugs, which are able to prevent in up to 80 to 90 per cent of the cases the evolution towards full-blown Aids. However, even when the treatment is successful and leads to no detectable viral load, the virus has not been eradicated and can still be passed to a partner during sexual intercourse. 

It is estimated that up to 25 per cent of HIV-infected people are ignorant of their positive status. Not only do these people miss out on the early treatment of their disease but, more worryingly, continue to contaminate others.

For this reason, health authorities is many countries now recommend broad HIV screening that includes an HIV test as part of a routine check-up and annual screening for such high-risk individuals as drug addicts, those with high-risk behaviour and those with multiple partners.

As infected semen, blood and vaginal secretions are the main sources of contamination, prevention relies on the practice of safe sex with HIV (and STI) screening before engaging in a sexual relationship and keeping relationships mutually monogamous. 

Emergency anti-viral treatment, which is more commonly known as post-exposure prophylaxis or PEP, is recommended to anyone who may have experienced ineffectively protected sex, as well as victims of rape and those who think they might have endured sexual intercourse while drugged with a roofie or drunk. Those who have been accidentally or intentionally injured by a potentially contaminated syringe or who has received a suspicious blood transfusion should also undergo a course of PEP. 

This preventive treatment given for one month has to be provided ideally within 4 hours and up to 72 hours after the contact. 

Thirty years on, HIV continues to pose new challenges. The introduction in 1995 of highly active therapy has resulted in a perception that preventive measures are less essential than before. In Thailand as elsewhere, the happy-go-lucky attitude towards sex among young people has resulted in high-risk behaviour, leading to the resurgence in HIV infection in this group. 

HIV requires sustained and adapted efforts from the health authorities, educators and of course parents in strengthening HIV awareness and education among adolescents and young adults. 

 

 

Dr Gerard Lalande is managing director of CEO-HEALTH, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at [email protected].