The looming HIV pandemic
Spread of the human immune deficiency (HIV) virus may not be reaching critical proportions yet, but the rate of spread in the Philippines is such that if the trend continues, there’ll come a time in the foreseeable future when it may have to be declared an epidemic.
Since the worldwide trend is similar, it’s not a remote possibility that an HIV pandemic is in the making. And that can really be a scary thought.
Irregular heartbeat
Several months ago, a 48-year-old manager of a big multinational company was referred to us because of an irregular heartbeat. It’s been the third time in three months that he had to be admitted for pneumonia, and the irregular heartbeat was just an incidental finding.
We assured the patient and his attending physician that the irregular heartbeat was nothing serious and that it was probably the least of his medical problems.
The attending physician was puzzled by the recurrent pneumonia. Obviously, the patient’s immune system was weakened. But for a 48-year-old man who was supposed to be health-conscious and who went to the gym regularly, as shown by his well-honed muscles, this was quite an enigma.
We didn’t give much thought to him remaining single although he had good looks, was very personable, and had a good-paying job. In short, he looked like an ideal husband material, especially in his younger years.
Tested HIV positive
His attending physician had a heart-to-heart talk with him, asking if he could volunteer any information that could assist his medical team who all seemed to be in a bind. He was reluctant at first, but later on he admitted having had sex with men, especially when he was on business trips abroad. He consented to being worked up for HIV/AIDS and he tested positive.
He’s getting appropriate treatment now; the last time I heard from his attending physician, he was still doing okay. He received intensive counseling on how to cope with his condition, living as normal as possible, and making sure he does not spread the virus around. He has learned his lesson, and has pledged to remain celibate the rest of his life.
If those with risky sexual behaviors (having unprotected casual sex or men who have sex with men) could be convinced to have themselves voluntarily tested, HIV carriers who may have no symptoms at all could be identified early enough and counseled on the prevention of this deadly virus.
Recent study, previous ones
No amount of drug prophylaxis can really be effective enough. A recently published study has shown that no amount of preexposure prophylaxis could be better than abstinence to prevent both syphilis and HIV infection. Unfortunately drug prophylaxis for HIV does not work, though it may appear to work in other sexually transmitted diseases (STDs).
Dr. M. Solomon and his colleagues also investigated preexposure prophylaxis among MSM to determine if syphilis infection was associated with acquisition of HIV.
Previous studies have already demonstrated a link between syphilis and HIV infection. The Preexposure Prophylaxis Initiative prospectively assessed the relation between prevalent and incident syphilis and acquisition of HIV infection in an identified group of HIV-seronegative men who had sex with men.
On screening, 333 of 2,499 participants (13.3 percent) had existing syphilis based on reactive syphilis blood tests. The incidence of additional syphilis diagnosis during the trial was no different between the actively treated drug and placebo groups.
The researchers reported 129 new HIV infections during the trial, and this new HIV infection rate was significantly higher among participants with syphilis than among those without them. The hazard risk was 2.6 times more, even after discounting other predictors or risk factors of HIV and sexually transmitted infections.
Experts on HIV and other STDs stress that high-risk individuals should be subjected to intensive counseling to enhance effectiveness of any prevention program. Unless they have a change of heart, any change in treatment programs would never be meaningful.
