Infektologist Ľubomír Soják.
There is an increasing number of people with HIV infection in Europe and Slovakia. Infectologist Ľubomír Soják of the University Hospital in Bratislava says that even general practitioners sometimes underestimate the virus. When you run a risk, you must test as quickly as possible.
What do you read in the interview?
Why infected grows
How HIV spreads
What is the difference between HIV and AIDS
What does HIV treatment look like today?
Heals HIV bone marrow transplantation
How many HIV-positive people do we have in Slovakia?
We know fewer than a thousand people. Some parts are abroad, for example in the Czech Republic and the UK. There is still a group of people we don't know and want to be treated. But we don't know how many of them are.
How many of HIV positive are treated?
About eight hundred people. The vast majority of course.
The number of HIV-positive people has recently increased. Why?
One of the causes is the more risky behavior. This virus appeared in the 1980s and the situation at the time was that when someone got it, it was immediately clear that he would die. People were scared. They now know that there is effective treatment, so they are less afraid. This can result in a more risky behavior and therefore a higher chance of getting an HIV virus.
So thanks to the advancement of medicine, people are less afraid of certain diseases?
Yes, it can be said.
Has the prevention failed in Slovakia?
I think the state did not fail. Prevention must be at the level of each person. Within Europe, Slovakia is a country with a low HIV virus, so we are doing well. Our effort as an expert rather influences other doctors to think about when a patient gets certain specific symptoms.
Some groups are strictly against sex education in schools. Is it the right attitude?
HIV is just one of the infections that can be transmitted sexually. Then there is still a large number of other diseases, such as hepatitis, syphilis, gonorrhea, HPV virus. So this problem is wide. Certainly, the education of young people at school should not be missed. The promotion of a healthy sex life is present.
When a patient is not treated, he / she dies
Is it possible to generalize what people are positive about in HIV in Slovakia?
Gay men are the most common in Slovakia. With anal contact, the risk of transmission of infection is greater, so they are more risky. But of course the risk is also in classic sexual intercourse. But in this group there are different people from different social groups, it cannot be completely simplified.
What threatens those who are not being treated?
This is pretty clear. If the patient is not treated, he may have a few years of pleasure and will not notice anything. But his immunity has gradually been exhausted. This can result in serious infections or cancer. It will inevitably die. The question is only the time for which death occurs and it depends on the patient. It depends on genetics or the type of virus. The fact is that when a person is not treated, he is threatened by a serious illness and hence death. But even at a later stage, the patient has the hope of rescue.
What is the difference between HIV and AIDS?
AIDS is the final stage of an HIV infection. If an HIV-positive patient is treated, he will most likely not reach the stage of AIDS. So HIV is not the same as AIDS.
Our goal is for people with HIV to lead normal lives
What does HIV treatment look like today?
Significant progress has been made in the treatment of HIV over the last 20 years and is now looking different. The patient takes much less medication, usually a combination of three medications. Today we can hide all three medicines in one tablet. Most patients we already have on one tablet take them regularly and the effectiveness and tolerability is excellent. The side effects profile is considerably lower than that of the nineties.
What does the normal life of a person with an HIV virus look like?
In theory they can do everything healthy people do. In essence, it is our goal – integrate into society and do the work that they have done before. Of course, patients with an HIV virus are under the strict supervision of doctors, they will perform regular blood tests and tests. We strive to lead a normal social and family life without limitations. Certain restrictions in sexual life must of course be more careful if they are injured. Otherwise they have a completely normal life.
Do they have a duty to report to doctors? Must all treating doctors say they are HIV positive?
Yes. They must tell all doctors. For example, dentists come into contact with blood and body fluids so that they must be informed. Similarly, all sexual partners must know that they have been in contact or in contact with an HIV-positive person.
Can doctors reject an HIV-positive patient?
Yes, and it's a problem. They are most often refused when they need surgery to bring their doctors into contact with blood. We already have a certain infrastructure of doctors that we work with, but sometimes there are problems. This makes it difficult for us, but the stigma is getting worse and working on it gradually.
Have you seen that the patient had been looking for a specialist for a long time?
Yes. But we are already a large center and we have our doctors here and know the latest insight into the disease. They know they don't have to worry when a patient is being treated. There is a problem with some investigations and then we improvise. But this is also the case for patients abroad.
The virus is not transmitted by hug, handshake or saliva
How is HIV transmitted?
It is a blood-borne disease. So transmission can happen sexually. In our circumstances it is no longer possible to transmit the virus through transfusion. Furthermore, it is mainly through syringes that are used multiple times, especially people who use drugs. Theoretically, from mother to child through blood. In the framework of Slovakia and Europe, every pregnant woman is routinely examined for HIV. If it is found positive, it immediately goes to us and heals.
With a special approach during delivery and postpartum, the risk of transferring the virus to the child is considerably reduced. In theory, an HIV-positive woman can normally become pregnant and have a healthy baby. We have several such children in Slovakia.
People often do not know how to treat an HIV-positive person. He is afraid of shaking his hand or being afraid that the virus will be transmitted through saliva. So how is physical contact with an HIV-positive person?
The saliva virus is present, but it has not been proven that it is spreading. Blood should therefore only come into contact with the blood when the virus is transmitted. The virus is not transmitted by saliva, by hug, by hand. It has been proven that our patients who live in a normal household with healthy people have never infected their family members. Of course they learn what to do if they get hurt and bleed. But this is a situation that does not happen routinely and often.
Are the diseases that HIV positive people have to watch out for?
Yes, but it depends on the patient and the stage at which he / she starts to be treated. They are asymptomatic patients, that is, what comes with HIV before they begin to manifest. Such people usually have good immunity and can live like normal people.
But then there are people who are at an advanced stage. We vaccinate them for some diseases, because if they got the disease, they would have a worse course. People in the last stage have immunity against cancer patients. Similarly, after chemotherapy someone knows what to look out for. The same applies to people with AIDS. They must look out for food, the environment in which they find themselves, they must avoid sick people or some animals and such.
At what age do your patients live on average?
We also have people who have been here for 30 years. They are already retired. In most cases we detect the virus on time, at a young age. When it comes to healing, his prognosis is basically the same as the prognosis of an HIV-negative person, meaning that he is probably living up to an age without serious HIV-related conditions. Of course, this infection is associated with a higher risk of certain diseases such as heart or kidneys. We know that and we try to prevent them from being obstructed by the right lifestyle or vitamins.
At what age do those who do not heal for HIV live?
Long ago, HIV-positive people were not treated once they discovered their virus, but waited for their immunity to fall to a certain level. Such treatment did not produce good results and people died earlier. This also suggests how untreated patients live. It takes about five years for an untreated HIV-positive person to develop AIDS.
Then he can easily get cancer or other serious infections and die. However, there are cases where such a patient can also be stored. It depends on a certain person. It is also associated with lifestyle. When a patient drinks alcohol, smokes or uses drugs, his chances of survival are lower. Today's HIV medicines have been on the market for ten years, so we don't have accurate evidence. I will appear in a few years.
Thus, even if the number of HIV patients increases, the quality of the treatment does not deteriorate.
The problem gets bigger. Europe is trying to stop this growth. Our aim is therefore to discover new cases and prevent further spread of viruses by using treatment. But I can say that I don't currently have a patient I couldn't cure.
Under which circumstances is HIV most often diagnosed? Do people only come on their own initiative or is it more likely that they will happen to someone else?
Usually patients arrive. They know that they are at risk and are going to test. Testing in Bratislava is free, anonymous, no problem. There are also options for self-testing. This group is the most common. Then there is a group of people who have to follow doctors: people before the operation or pregnant women. They will be tested for HIV and in some cases an HIV infection can occur.
And then there are the symptoms that every doctor should think. It should be tested for HIV when it appears to the patient. The final diagnosis is already in the final phase of the most serious diseases.
You can test anonymously and for free
What are the most important symptoms of an HIV virus?
Two to four weeks after infection, the patient may have flu, skin rashes, mouth sores. Ideally, we capture the patient at this stage. But only those who know they are in danger will come to this. Those who don't think of HIV at all with these symptoms. Gradual weakening of immunity starts at a higher stage. The patient gets more infections, such as pneumonia, shingles, fever, lean, swollen nodules. The final phase of AIDS is manifested by a blood cancer or an infection that does not endanger ordinary people but can kill people with HIV.
Not many people think of HIV for the first time. Mouth ulcers are common in some people.
Yes, but they are atypical ulcers, for example, they last longer. Or that the patient gets the flu from the flu season. When a person knows that he has a risky behavior, he should think about it. But it is clear to me that we cannot catch all people. We also try to influence practitioners to think about it.
When a person decides to do HIV testing, what's the possibility?
In Bratislava we have an AIDS center at the Slovak Medical University, where they test for free and anonymously. They are also mentioned. check points where you can also test anonymously, usually from a drop of blood. Tests that detect the presence of the HIV virus in the saliva can also be purchased at the pharmacy. These methods are sensitive enough that there is a good chance that they will catch the virus. When this is confirmed, one should go to the doctor for a detailed blood test to confirm or refute it.
Is it a recommended time for someone to test for risky behavior?
Yes. Antibodies begin to form within a few weeks, until that time the virus is not visible in the blood. Ideally, someone should test about a month after a risky behavior. If the results are negative, testing is repeated for three months or half a year to confirm this. refuted.
Abroad, bone marrow transplant patients have been able to completely suppress the HIV virus. Is it possible to treat HIV in this way?
This is not going to be the method that we use. Bone marrow transplantation itself is a risk perception where the patient can die. Bone marrow was transplanted to these patients due to a different cancer diagnosis. What followed was more or less coincidence. The bone marrow donor had a mutant type receptor that prevented the HIV virus from "sticking" to the cell and became resistant to the HIV virus.
Such people are present in a small percentage of the population. We even have a small group of people who get the HIV virus, but without medicines they can keep it safe because of their genetic equipment. They are called elite controllers. I can control the virus myself. Research to fully cure the HIV virus is still ongoing. The real way to heal itself is quite long, but I don't think bone marrow transplantation will be like that. Gene therapy is more likely.