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HIV-infected, who starts treatment before the age of twenty, can live up to seventy – says Anita Wnuk, MD, PhD, infectious diseases specialist from the Provincial Hospital in Szczecin.
Someone finds out they have HIV. She begins to wonder when he might have contracted the virus. Can it be determined?
Anita Wnuk, MD, PhD: – It’s not that easy. The time of infection is important to the doctor and we are able to determine it more or less on the basis of tests. But the interpretation of the results of these studies is difficult because everyone has a different organism, a different immune system. HIV infection progresses differently in each patient. In one patient, it may seem to us that the infection was 10 years ago, compared to two years ago. Just because someone is having bad results does not necessarily mean that it is an infection that lasts a long time. It may be the other way around. The patient may have a weak immune system because he or she is genetically equipped, and then the infection progresses faster and the results are worse. Another may be 18 or 20 years old and have a good record. The type of virus is also important because it is not just one HIV virus. The genotypes of these viruses vary from region to region. There are weaker and stronger viruses. The route of infection with the virus is also important. As a rule, the progression of HIV infection by intravenous drug administration is slower. We have noticed that infection through sexual contact is progressing faster. The virus is then more malicious, different. It has a different biology. In fact, each patient has an individual history. Even if the partners are infected, one gets sick differently from the other.
If someone has had risky sexual contact, it is not surprising that they will apply for HIV testing. He just had a reason. What, however, worries people who did not have such sexual contacts and decided to get tested? Have any symptoms of infection?
– The disease is a later stage. Symptoms of HIV entry are not specific and look like an ordinary viral infection. Half of those infected have no symptoms. Patients read various things on the Internet, which are complete nonsense, for example that HIV-infected skin changes, hair is duller … The most important thing is awareness. I had risky contact – I’m going to get tested. Symptoms of the disease appear late, after several, dozen or several dozen years from the moment of infection. They are quite typical. There are lists of disease entities that may suggest HIV infection (including tuberculosis, bacterial pneumonia, recurrent salmonellosis sepsis, bronchial, tracheal and lung candidosis, mycobacterial infections, brain toxoplasmosis, visual loss retinitis, encephalopathy, Kaposi’s sarcoma , invasive cervical cancer). Doctors who see patients with these conditions need to know that this may be due to an immune disorder, including HIV infection. Recently, new recommendations of the Polish AIDS Scientific Society regarding testing patients for the presence of HIV have appeared. In 2006, the World Health Organization developed such recommendations for the American population, and in the United States all persons between 13 and 65 years of age who go to any health care facilities are tested. Test persons are obligatory. There will be no such restrictions in Poland, but we want to introduce the obligation to test patients with specific diseases. For example: tuberculosis. If someone is hospitalized with suspected or diagnosed tuberculosis, they must be tested for HIV. This also applies to diseases that are dealt with by oncologists, ENT specialists, paediatricians, ophthalmologists, endocrinologists, doctors of internal diseases, infectious diseases, pulmonologists and family doctors.
Does the patient have to consent to such an examination?
– The patient does not have to give his consent in writing. He had to. We are, of course, not talking about someone who volunteers for HIV testing, but about someone who, for example, went to a hospital. Until now, such a patient had to consent to the examination in writing. He was given a specific document and signed it. He will now be told orally to test for HIV. If he does not agree to such an examination, he will have to sign a document stating that he does not consent. From year to year, fewer and fewer patients are tested in Poland. We are the last in Western and Central Europe in terms of the number of HIV detection tests. We have Turkey, Romania, Slovakia, the Czech Republic and Ukraine ahead of us. I am talking about the number of tests in patients admitted to hospitals or clinics, not people who volunteer for tests. This is due to the reluctance to test. The cost of such a test is not high. They are about 30 zlotys. And doing it would be of great benefit to the patient. Let us give an example: a patient who is treated in hospital for tuberculosis. He is 4 months in a pulmonary ward and this tuberculosis does not respond to treatment, which is quite expensive. Only after four months it turns out that it is HIV, so we have four months of unnecessarily spent money on tuberculosis treatment. If we do this examination right away, this patient is at home after four or two months. Treatment for tuberculosis and HIV remains. The patient is recovering nicely. The second group where HIV testing is mandatory (and we’re not talking about diseases anymore) is pregnant. The recommendations for gynecologists are that all pregnant patients must be tested in the first trimester. The gynecologist will refer you for these tests. A woman with HIV can give birth to a healthy baby, but doctors need to know she is infected.
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How is HIV treated?
– It’s not like a patient who is diagnosed with an infection gets medication right away. You have to watch him first. The cost of treating one patient is about four thousand zlotys a month. However, the patient does not pay for this treatment. The treatment is lifelong. The drugs we give have serious side effects. There are patients who choose not to take therapy or stop it. Sometimes there are difficulties in accessing drugs – related to the flow of money, tenders. Patients do not stop treatment then, but they have changed preparations, which is not beneficial for them. Patients themselves are used to the fact that these drugs have always been and will be, and they expect them to be so. It is difficult for us to mobilize them to fight for theirs. The problem is also with patients who also have liver diseases. Some had to have intermittent treatment, and it ended tragically.
Let’s talk about the side effects of using medications.
– Doctors try to minimize the side effects of drugs. But sometimes you have to use very strong sets. When a patient starts treatment with a strong drug and there is an effect, he is reluctant to change it to a weaker one, because there is a rule that such treatment is continued as long as it is possible. The effect of using drugs may be diabetes (although it occurs relatively rarely, after a long period of time and rather in predestined people, i.e. those who have someone with diabetes in their family). A change in appearance may also occur, which is very poorly received by patients. Sometimes they stop treatment or try to change their medications. Under the influence of drugs, liver or pancreas damage, anemia may also occur. We do not know what the effects of treatment will be in people born to HIV-infected mothers who go to therapy from the beginning and are now at the age of puberty. We do not know what the effects of the use of drugs on the offspring of women who were treated, for example in their 20s, and are now getting pregnant. It is not known what this long-term antiretroviral treatment caused in the reproductive cells – the egg or the sperm.
How long can you live with HIV?
– It will sound strange, but you can live … for the rest of your life. So as if you didn’t. There are mathematical simulations made, which show that a person who begins treatment before the age of twenty may live for another 50 years, i.e. up to seventy.
Marta Blik interviewed
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