Waiting to exhale
It is not often that I’m surprised by new data about HIV and other sexually transmitted diseases. But I was taken aback recently when data in Salt Lake County and in the State of Utah showed that almost 30 percent of new HIV cases are being diagnosed at the late stages, where AIDS is part of the picture. This same data showed that only 25 percent of cases are being diagnosed early, when the immune system appears to be functioning at a high level and when infection likely occurred within the past two years.
The high number of cases being diagnosed late in the disease is worrisome to me for a couple of reasons. It indicates that a significant proportion of men out there who are in the highest risk category for acquiring and transmitting HIV are not getting tested regularly or in some cases are not getting tested at all. I often see patients who identify as men who have sex with men and who report never having been tested or its been over 10 years since their last test. I often get the sense that fear is what is driving this. I simply didn’t realize that the number of men falling in to that category was quite so high. Negative consequences are much more likely to occur whenever a patient is diagnosed late in the progression of the disease.
In 2006, the Centers for Disease Control and Prevention came out with new recommendations that everyone 18-64 years of age be routinely screened for HIV as part of their annual exam. The intent of this recommendation was twofold: First, to normalize HIV testing as part of a new social paradigm and, second, to allow us to identify cases in people who were not actively seeking testing. The Salt Lake Valley Health Department and much of public health also recommends that anyone who is engaging in high-risk behaviors be screened for HIV every six months. Those who are at highest risk for contracting HIV are men who have sex with men and people with a history of intravenous drug use.
When a patient is diagnosed late in the course of the disease, or when too much time passes after a patient is infected with HIV and then seeking HIV-related health care, damage to the immune system may not be repairable. There seems to be a social norm among some MSM that they don’t need to get tested or see an HIV physician until they become sick. The thinking is that when they reach that point of poor health, then they can start seeing an HIV doctor, get the HIV drugs and things will be fine.
HIV affects the immune system; it impairs the body’s ability to provide protection. The primary mission of HIV is to infect as many healthy cells with the virus as possible, thereby exhausting the body’s immune system so it can no longer do its job. HIV drugs, referred to as antiretrovirals are designed to interfere with the virus’ ability to replicate or to infect healthy cells.
When a patient’s immune system becomes compromised before medical intervention occurs, there is no guarantee that the immune system will fully recover, even with HIV antiretrovirals. If a patient is not diagnosed until late in the course of HIV, where they are immune-compromised, the patient often requires extended hospitalization for opportunistic infections or other health consequences. They may not recover from these infections despite the medical intervention and may die. They often require significant follow up, and are burdened with large hospital bills. They often experience more complications from the antiretrovirals and never develop fully functioning immune systems. The quality of life moving forward is more likely to be compromised.
In an ideal world, we would be able to diagnose all HIV infection at its earliest stage or shortly after the infection occurs. Early medical intervention provides the best hope for a positive outcome and will allow those with HIV to experience the best quality of life. In order for this to occur, everyone needs to be tested at least once a year. Anyone who is considered to be high risk for HIV should be tested every six months. HIV testing has advanced to the point where test results are now available within 15 minutes. Many agencies in Salt Lake County offer free or low-cost testing to the community on a regular basis. The Salt Lake Valley Health Department offers free HIV testing at the Pride Counseling Center, 124 S. 400 East, the first Monday evening of each month, 5-7 p.m.
To find out more about HIV testing in Salt Lake County, please call 385-468-4242.