Is testing actually declining because of the pandemic?
Prof. Alicja Wiercińska-Drapało: There are some statistics that say only 5% of Poles have done HIV testing, some say that 10%. How many have really done - no one knows because these surveys are done anonymously. In Poland we have about 26 thousand confirmed cases – according to the data from the National Institute of Public Health - National Institute of Hygiene (NIZP-PZH). We have about 15,000 people on antiretroviral treatment, and these are the patients under ongoing care - we know the most about them. Poland, like other Western European countries, has access to all antiretroviral therapies. Successful antiretroviral treatment makes an HIV-infected person noninfectious to their sexual partners. This is probably why HIV infection is not so common in Poland. The problem is, however, late diagnosis, often at the stage of full-blown AIDS. This makes it very difficult to treat these patients, and the chances of living a long life are also much lower. And today we know that a HIV-infected person diagnosed at an early stage of infection can live as long as peers without infection. Therefore, HIV testing should be done as widely as possible. On medical grounds - for all symptoms that concern the doctor. The current pandemic situation is not conducive to diagnosing HIV infection - Anonymous Testing Sites have been closed for a long time, medical appointments often take the form of online consultations, all attention is focused on COVID-19. In the Department of Infectious and Tropical Diseases and Hepatology MUW, one of the few places in Poland where HIV positive patients are currently hospitalized, there are still patients in a serious condition, with newly diagnosed HIV infection - at the AIDS stage. Unfortunately, we will not be able to help everyone. These are unnecessary deaths that could have been avoided if the diagnosis had been made earlier.
The relatively small number of confirmed cases may lull people into a false sense of security, hence few tests are being done.
A.W.-D.: It would be good for physicians of different specialties and primary care physicians to think about HIV more often. For the most part, infections are diagnosed at Anonymous Testing Sites, to which people apply themselves. There, infections are diagnosed at an earlier stage. Symptomatic patients see a doctor - but quite often various tests are performed, often very expensive, often invasive - and a simple, inexpensive HIV test is done at the end of the diagnostic process. Infectious disease specialists dealing with HIV have long been reminding people of the need for anti-HIV testing in many clinical situations. Recommendations are directed at specialists in other fields when anti-HIV testing is necessary. In short, whenever a patient's condition or laboratory tests are of concern to the physician. Taking into account the epidemiological situation in Poland, most often physicians will encounter an anti-HIV negative result. But it is better to rule out 100 or 1000 times than to miss once. Sometimes you just need to direct the patient, you can always say "please take a test". There are Anonymous Testing Sites where any person can take the test anonymously and free of charge. Today, you can buy at-home test and make it yourself. If the doctor says nothing about HIV, the patient feels relieved of thinking about HIV. Usually, the doctor learns about risky behaviors that increase the possibility of HIV transmission from the patient when we have already diagnosed HIV.
Is a long and normal life with the virus possible?
A.W.-D.: At the prestigious CROI 2020 conference, a major analysis was presented in which it was reconfirmed that an HIV-infected person can live just as long as their HIV-uninfected peer. People infected with HIV in Poland have a very well organized medical care, also in terms of accompanying diseases such as diabetes, cardiovascular diseases and kidney diseases. People who are infected with HIV, but receiving treatment, are doing their jobs, having fun, and functioning just like other people. This is very good news, known to us for several years. We also know that people with HIV can safely start families. There is a rule: u=u (undetectable = untransmittable). This means that if a patient has an undetectable viral load for at least 6 months - they are not transmitting the virus, they are non-infectious to their partners. There is hard evidence for this. Medical advances in HIV have been immeasurable. New therapies are appearing, so-called long-acting. The access to injection therapy, administered once every two months, is expected soon. On the horizon, in clinical trials, there are drugs given once every six months and in preparation once every year. But you have to live till that time. And to live, you have to be diagnosed and treated.
There used to be talk of a vaccine for HIV. Is there a chance for one?
A.W.-D.: I wouldn't count on a vaccine because it is an extremely variable virus. What we already have is pre-exposure prophylaxis (Pre-exposure Prophylaxis – PrEP). It uses antiretroviral drugs effective in inhibiting viral replication. Individuals take medication before engaging in risky behaviors. If someone takes these medications continuously, they will not succumb to HIV infection. We have about 5,000 such patients. If someone does not want to change their lifestyle, prevention is better than the cure. However, it is important to remember that PrEP does not protect against other sexually transmitted diseases.
It means that testing is the key in HIV prevention.
A.W.-D.: Exactly. It is worth remembering that special written consent is not required to order an anti-HIV test. Your doctor should always order an anti-HIV test as part of the diagnosis of worrisome clinical symptoms or abnormalities in laboratory tests. The consequences of not doing the test and the drama that ensues, and which we are seeing here - are often irreversible.
Since 1988, December 1, at the initiative of the World Health Organization (WHO), is celebrated as World AIDS Day. Its main aim is to draw attention to the problem of HIV/AIDS infection and to show solidarity with people affected by the disease. There are 38 million people living with HIV/AIDS worldwide, 1.7 million people were diagnosed with HIV infection in 2019, 690,000 people died from AIDS-related illnesses. At the end of March 2021, there were approximately 13,605 patients receiving ARV treatment in Poland, according to the Ministry of Health. The treatment is provided and funded under the Ministry of Health's health program entitled "Antiretroviral treatment of people living with HIV in Poland for 2017 – 2021."