[jason19870313]

Q. What is the difference between HIV-1 and HIV-2?
A. HIV-1 and HIV-2 are very similar in many ways. The route of transmission is similar. The main difference may actually be in the clinical manifestations; it would appear that HIV-1 has a more aggressive course while HIV-2 patients tend to survive longer.

Q. How do you diagnose this infection?
A. This usually involves some blood tests. The technique used is often the ELISA test which can be done in many clinics and hospitals throughout the country. The results come back usually within one or two days and it tends to be very sensitive (therefore with the possibility of false positive results). Because of this, testing should always be done with counseling because interpretation of the results can sometimes be difficult.

Q. How would I know if I have HIV?
A. The blood test would be the way to know as described above. However, I think it is important that one should asses whether actual exposure has occurred (risk behavior e.g. unprotected sexual intercourse, sharing of needles, etc.)

Q. Does everyone who has HIV infection die of this disease?
A. 95% of patients with HIV will gradually progress to AIDS (the terminal stage of HIV infection). This process may take anything between three to twelve years depending on the individual. However, there is a small group of about 1 - 2% of HIV positive patients who do not appear to progress/or progress very slowly (long term non-progresses) and they appear to sometimes remain asymptomatic for more than 15 years. However, if one were to follow them up long enough they may one day still land up with AIDS.

Q. How do you get infected with this disease?
A. The three main ways of HIV transmission are: unprotected sexual intercourse, (both gay/straight), sharing of needles among IV drug users and infected mother to her unborn child.

Q. Is it true that the HIV virus kills the white blood cells? If it is so, would an anemic patient have more defense capabilities compared to the average person?
A. The function of the white blood cells is often linked to the immune system of the individual. Whereas, anemia is actually a deficiency of hemoglobin which is found in red blood cells. So, unfortunately your above theory may not work in clinical practice.

Q. What is the percentage of babies getting infected from HIV-infected mothers?
A. 30% without treatment.

Q. If a person has sexual intercourse with an infected female, what is the chance of him getting the disease?
A. The risk of vaginal intercourse without protection may vary between 0.1 to 0.01%. However, there are many other factors which can increase transmission including the presence of genital ulcers, the type of sex act actually performed, sex toys etc. etc.

Q. Are there any other methods of spreading HIV besides sexual intercourse, inheritance and blood transfusion?
A. As mentioned before there is a 30% chance of transmission from an infected mother to her unborn child. You are right, transfusion using contaminated blood will certainly transmit the infection. However, in many developed countries including Malaysia all blood used in blood banks is screened for HIV.

Q. What would be the average life span for a person who has been diagnosed with HIV when he/she was an infant?
A. Children infected with HIV tend to do poorly compared to the adults. While the adults may survive more than ten years without any symptoms, many children actually die before the age of six without treatment. However, there are some fortunate children who actually survive until their teenage years but their numbers are small.

Q. The blood tests only tell you after your body has produced the HIV antibodies. How do you find out whether you got the infection immediately after having sexual intercourse with a prostitute?
A. Be patient. You have to wait for sometime even if you use the newer (and usually used in research) antigen test you will still have to wait for a few weeks.

Q. Is the female at risk when she does have sexual intercourse without a condom but she is on the pills?
A. The pill won't work. The issue here is not contraception, the issue is 'barrier protection'. Therefore, the condom works while the pill doesn't.

Q. Can HIV be transmitted through the act of oral sex or French kissing?
A. Yes. However, the risk is significantly lower than anal or vaginal intercourse. In oral sex, the person performing the act runs the higher risk but some couples use the oral dam which acts as a barrier or oral sex with a condom. French kissing has relatively low risk unless there are lesions or cuts in the oral cavity.

Q. Why do some people progress rapidly to AIDS while others take a long time?
A. There are two main factors for this. Firstly each individual responds differently to the virus and the immune response mounted against the virus after infection varies a great deal. Some people can suppress the virus much better than others and therefore, they intend to progress much slower. However, they are still HIV+ and they can still transmit the virus. Secondly, the viral strains may also be one that is less pathogenic and therefore does not destroy the immune system as rapidly.

Q. What kind of treatment do HIV-infected pregnant women receive so that their child would not suffer the same fate?
A. We can provide some anti-HIV drugs given to both mother and to the newborn child (examples AZT and Nevirapine) which can effectively reduce transmission from mother to child by 50 to 66%. For your information, our Ministry of Health is providing free AZT for all HIV infected mothers to prevent their babies from getting infection.

Q. Do condom protect one completely from getting AIDS if one practice casual sex often?
A. The efficacy of the condom is dependent on the quality of the condom itself as well as the technique of putting on the condom. However, the studies suggest that the efficacy of STD prevention may be anything between 90 to 99%. Although I agree with you that it does not completely remove the risk of HIV infection certainly if sexual intercourse is taking place with an 'unknown or uncertain' partner some protection is better than no protection.

Q. Would women with woman condoms get AIDS if they practice casual sex often?
A. Female condoms will also reduce HIV transmission. However, the issue is availability (not easily available) the cost is much higher than the male condoms and some of them can be bit 'noisy'. Yes, it will certainly reduce infection.

Q. Based on your answer, blood transfusion or sharing of needles by drug users is known to transmit HIV. Why can't mosquitoes or lice be vectors of transmitting HIV since they do carry other diseases through their bites?
A. We can answer this question in two ways.
1. There has been no documented cases of people infected from insect bites. If indeed mosquitoes could transmit the virus the rates would be higher than our dengue rates in Malaysia and the global rates of HIV will be as high as the malaria infection rates.
2. Some researchers have found that enzymes in the digestive tracts of some of these insects may actually hamper the fitness of the virus.

Q. How come HIV virus can be transmitted outside the body? like for instance thru a needle?
A. HIV transmission requires a very direct route for eg. in sexual intercourse there should be penetration and in drug users there should be sharing of needles with contaminated blood inside. I think that you are asking me whether the virus can survive outside the body for a prolonged period of time. The answer to that question is no, however, I have to qualify that statement. If the blood is dried and coagulated the risk of transmission is significantly reduced whereas the risk of transmission is much higher if the blood is still fresh.

Q. Dr Bella, you mean to say that a person has only 0.1 to o.o1% of getting AIDS if he has intercourse with an infected person. What about Anal sex ,what is the chance of infection then?
A. Anal intercourse has a higher risk and it can vary between 1 to 10%.