Doomsday scenario for HIV/AIDS is up to us | Lifestyle.INQ

OCTOBER 27, 2022

After reading our column last week (“The AIDS virus is mutating fast,” PDI Lifestyle, 10/23/18), a medical colleague sent a message: “Are you predicting a doomsday scenario wherein the AIDS virus would multiply fast and be incurable?”

I texted back: “Not really, but couldn’t rule that out, too. Just citing experts’ opinion.”

It can swing both ways, said Dr. Edsel Salvaña, an expert on HIV/AIDS and other infectious diseases, whom we quoted extensively in the same column.

If the public religiously adheres to all the precautions prescribed by experts to prevent HIV transmission, and high-risk individuals get diagnosed and treated early, the prospect is good.

On one hand, we may be able to convert this dreaded disease into a controllable chronic medical condition, in the same vein as high blood pressure, diabetes and chronic lung disease.

On the other hand, if we throw caution to the winds, then HIV/AIDS will resurge with a vengeance in multiple mutated, potent and drug-resistant types. So, we actually get to decide the long-term outlook.

Increased 16 times

An ongoing public health information campaign on HIV/AIDS initiated by the Department of Health is warning the public that the number of newly diagnosed cases of HIV+ in the Philippines daily has increased almost 16 times.

But the painstaking research of Dr. Salvaña and other local experts has identified the particular subtype, which is now dominant among HIV+ Filipinos, as well as the effective treatment for it. So, despite the alarming increase, effective control appears to be within reach.

This can also be disquieting, however, because if the rate of increase continues, the subtypes into which the current dominant HIV could mutate are likely to become drug-resistant to available treatments.

Best treatment is still prevention, experts say. The most common mode of transmission is still through sex—either vaginal or anal. Sharing injection needles with someone who’s HIV+ could be another mode of transmission.

Transmission will occur only if the HIV in body fluids (blood, semen, vaginal fluids, rectal fluids, breast milk) come in contact with the thin, delicate mucous membranes of the body or any damaged tissue, or if the fluids like blood are directly injected into the bloodstream of an HIV(-) individual. Potential entry sites are mucous membranes inside the anus or rectum, vagina, the opening of the penis, and the mouth.

One should not worry, though, of possible HIV infection through transfusion or organ transplantation. All hospitals are very strict in testing for HIV and other transmittable viruses like Hepatitis B and C.

One of the tragedies of HIV/AIDS is that an infected mother can also spread HIV to her baby during pregnancy, childbirth and breastfeeding. Detection of HIV+ mothers can prevent this with proper treatment.

There’s a small risk one can get HIV from torrid kissing, and there is minimal risk when there are sores in the mouth or genitalia, and bleeding gums. Same relatively low risk of transmission is true for oral sex, provided a barrier (condom, dental dam) is used.

Don’t be paranoid

Although public information campaigns stress avoidance of contact with HIV+ individuals, particularly if there’s full-blown AIDS, one should not be paranoid about getting the virus with casual contact. You can shake hands, hug or have a closed-mouth kiss with someone who’s HIV+.

Same thing if you come in contact with objects used by the HIV+ individual, like toilet seats, doorknobs or dishes.

I have an acquaintance who used tissue paper whenever he opened toilet doors, and used his own set of utensils when eating. It took us some time to convince him that such precautions were unnecessary.

For couples in which one is diagnosed to be HIV+, normal sex is still possible once the virus load in the afflicted spouse is sufficiently suppressed.

The couple should wait for an expert to advise them when it’s safe to resume intimacy. The virus load can be suppressed with an available treatment for HIV called antiretroviral therapy (ART).

Some experts allow even earlier resumption of sexual activity with pre-exposure prophylaxis (PrEP) for the HIV(-) partner.

For those who had a casual high-risk encounter “after a moment of weakness,” a post-exposure prophylaxis (PEP) may also be prescribed by an infectious disease expert, initiated within three days of the exposure and taken for 28 days.

PrEPs, PEPs and ARTs are not over-the-counter medicines, and should be taken only with strict expert supervision.

So, a diagnosis of HIV positivity does not come with life-limiting implications. One may unfortunately have been infected, but it’s not the end of the world for him or her. The important thing is to diagnose it early enough.

Everyone must be tested, particularly those who have risk factors—multiple partners, unprotected sex, MSMs (males having sex with males), substance abusers (especially those using injections and sharing needles).

Doctors, nurses and other healthcare professionals who get occasionally exposed to body fluids of patients with no chance to take precautions (as in emergency cases, or in the operating room) should also be tested.

Although around 35 million have already died of AIDS, we also hear of many who have lived normal lives despite a diagnosis. The world was shocked when NBA superstar Earvin “Magic” Johnson announced 27 years ago that he had tested positive for HIV.

The diagnosis ended his successful NBA career, but not his life, and the healthy, meaningful way he has lived it since. He remains healthy while being on ART.

He’s not cured, and will likely never be, but just like someone with controlled hypertension and diabetes, he may still live a happy, normal life, and see his children’s children grow up.

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