Ask The Experts: What are the treatment options for people with HIV and how can they lead a fuller life?

Q I am a 48-year-old man who has been newly diagnosed with HIV. I heard that HIV patients live for only a few years, and am afraid of transmitting the virus to my loved ones. What are some treatment options available for me?

Being infected with the human immunodeficiency virus (HIV) can be controlled with proper treatment. Patients who are on successful treatment pose no risk to others. Recent advances in treatment have significantly reduced death rates and prolonged life in those who are able to maintain good control over the infection.

Patients receive Highly Active Antiretroviral Therapy, which involves using a combination of drugs to treat the infection, and keeps the infection well controlled. This allows them to have a normal life expectancy and not transmit HIV to their partner.

This therapy has become better and better tolerated with only minimal side effects.

In the past, patients had to take multiple tablets several times a day which was very inconvenient and not sustainable for those who have difficulty swallowing tablets.

Future HIV treatments will include more options to help people who tend to forget to take their medication.

These options are also convenient when our patients travel or live with their parents who are often not aware of their HIV status. Such options have become available in some countries and we hope for them to be registered in Singapore as well.

Modern HIV drugs are much better tolerated and most are subsidised by the government, allowing patients living with HIV access to effective, well-tolerated and affordable treatment.

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Q How many people are diagnosed with HIV in Singapore?

Data from the Ministry of Health shows that there were 261 persons diagnosed with HIV among Singapore residents in 2020. There has been an overall decrease in these numbers over the past few years.

Q How will my treatment for HIV be determined?

Once a diagnosis is confirmed, the procedure includes the doctor working with a pharmacist and social worker to determine options suitable for a patient.

The social worker helps decide which regimen is most affordable and how it should be financed, based on the patient’s finances, while the pharmacist checks for any interactions with other medications.

Certain combinations cannot be used if there are other co-infections such as hepatitis B. Those with kidney disease may not be able to tolerate some agents which can worsen kidney function.

Once the team has shortlisted a few options, they will consider the patient’s preferences. For instance, some patients may want to get their viral load down as quickly as possible because they are very worried about exposing their sexual partners. Others are concerned about the costs.

The final choice of the HIV regimen is a result of close collaboration between the multidisciplinary team and the patient.

Q I am worried about speaking to my doctor. How should I go about doing it?

It is extremely important for the patient to speak to their doctor openly about treatment.

Newly diagnosed patients often visit clinics feeling fear and often shame due to the stigma surrounding HIV. As healthcare providers, we show sincere empathy and support without judgment so that we can start a good patient doctor relationship and allow the patient to share their expectations and worries.

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We encourage clinics to show such levels of empathy so that patients feel empowered and comfortable to share their concerns.

Q I am afraid of being stigmatised by my family, friends and society. How can I control the virus and still carry on living a good quality of life?

Naturally, the first goal of the healthcare provider is to facilitate a return to full health.

Once a person living with HIV achieves a good control of the infection, they can look forward to a long and improved quality of life like anyone else.

Many individuals with HIV are anxious about starting a relationship because they are afraid of infecting their potential partners. Fortunately, with the current treatment, they can be reassured that if they take their medication every day and the virus is suppressed to what we call undetectable levels, there is no risk of HIV transmission to their sexual partners. This is known as “Undetectable equals Untransmittable”.

Patients are also encouraged to take their partners to the doctor so that he can address any worries they may have about HIV transmission.

Q What are some subsidies available for PLHIVs?

When the first HIV drugs became available, they were extremely expensive. Now, most HIV drugs are subsidised by the government.

Patients can also use their Medisave to pay for antiretroviral treatment. For needy patients, there are options such as Medifund or other funds to tap on. This advertorial is meant for educational purposes only and does not endorse, make reference to and/or recommend any product.

This advertorial is meant for educational purposes only and does not endorse, make reference to and/or recommend any product. This advertorial contains information on service(s) supplied by a third party. Any reference in this advertorial to such third party and/or service(s) does not constitute or imply the endorsement or recommendation of such third party and/or service(s) by the National University Hospital.


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