Saturday, February 27

Medication – the vital lifeline for HIV patients


Dr Wong Toh Mee

WHEN Abdul (name has been changed) decided to go for an HIV (human immunodeficiency virus) test at age 27, he didn’t have any symptoms.

He tested because he wanted peace of mind, considering his wild lifestyle while he was living in Sabah. He was hoping the result would come back negative but his heart sank two weeks later when he learned he was HIV-positive.

That was eight years ago. And today, at 35, he still looks healthy despite living with HIV all this time – thanks to the medication he takes every day.

Abdul needs to see his physician Dr Wong Toh Mee at the Sibu Hospital every six months. For him, strict adherence to his medication regimen is a must to enable him to lead as normal a life as possible.

He started taking medication three years ago.

“The policy is that they have to wait until your CD4 drops to 300 and my CD4 only dropped to below 300 three years ago – that was when I started medication,” he said.

Reported HIV and AIDS, Malaysia 1986-2018. — Source: Ministry of Health

The CD4 count is like a blueprint of how well the immune system is functioning. CD4 cells, also known as CD4+ T cells, are white blood cells that fight infection.

When he began his medication, there were side effects like dizziness and constant vomiting which went on for about a month. But throughout the ordeal, Abdul remained very disciplined in taking his medication.

“Once I fixed the time for it, I set the alarm so that I would never forget,” he added.

Dr Wong said the treatment Abdul is getting is called active antiretroviral (ARV) therapy.

The government requires that once diagnosed with HIV, patients must undergo such treatment regardless of their CD4 count.

This first line therapy has been provided free by the Health Ministry since 2006 as part of the government’s effort to render Malaysia free of HIV and AIDS cases by 2030.

Distribution of reported HIV cases by age group, Malaysia 2018. — Source: Ministry of Health

However, Dr Wong explained if patients broke the first line – that is when they did not take their medication properly and the virus had become resistant – expenses for the second line ARV treatment would be borne by the patients themselves. She said while this did not happen very often, young people tended to break the line.

“They thought once they had taken medication for two or three years, they would already be fully healthy. But when they came back, their condition would be worse than before.

The Red Ribbon is an awareness ribbon, used as the symbol for the solidarity of people living with HIV/AIDS.

“Once patients go for treatment, it’s for life. If they take treatment properly, it can prolong their lives and allow them to live normally,” she noted.

Dr Wong always reminds patients to treasure the first line therapy.

“The hospital can change the medication for the second line therapy but for the third line therapy, there will be no change of medication.

“I usually tell patients to treasure their first line therapy, We’ll select the medication according to their living habits and see how it works. If they can tolerate the first line medication, they can stay with it for a longer time.”


No longer death sentence

She said HIV is no longer a death sentence although people living with the virus could also contract other ailments such as high blood pressure, diabetes and heart diseases, adding, “These are the diseases that will kill them rather than HIV.”

When meeting with HIV patients, she explains to them HIV is a chronic disease and there are ways to protect themselves and others.

According to Dr Wong, ARV therapy is also important for HIV-positive women who are pregnant as it can prevent transmission to their babies. Through medication, the virus will be suppressed, lowering the risk of transmission to the baby.

In 2018, the Health Ministry reported about 99 per cent of pregnant women living with HIV received ARV therapy to reduce of Mother-To-Child Transmission (MTCT).

She said to lower the number of HIV patients, the Sibu Hospital is providing free HIV screenings.

Dr Wong who also gives public talks on HIV and AIDS awareness, said people who thought their risk was high could come to the Sibu Hospital for a check-up. While new cases are declining every year in Malaysia, she reiterated leading a healthy lifestyle is important as, “HIV can infect anyone.”

According to the Health Ministry, at the end of 2018, an estimated 87,041 people were living with HIV while in the same year, over 70 per cent of new HIV infections were reported among the 20 to 39 age group.

HIV cases are purportedly getting younger proportionate to the increase of adolescents and young people between 13 and 29 years old.

Dr Wong said transmission is commonly through sexual behaviour and needle or syringe use, adding that about 90 per cent of the young population got infected through the former.

She revealed that the Sibu Hospital also counsels HIV patients and their families.

“If a spouse has HIV, the partner must be screened as well and if a mother has HIV, her young child must also be screened.”

Dr Wong said while many patients tested had accepted the results, some were in denial.

“Normally, they will get a second or third opinion. Once they have done this, we’ll normally ask them to tell a family member or a good friend. We call it the circle of confidentiality. In the beginning, they will find it hard to tell anyone, so we will also counsel the family members.”

The hospital also provides counselling for married couples who want to have children.

At the moment, there are no support groups for people with HIV in Sibu.

The Health Ministry has said young HIV cases are often subjected to stigma, discrimination and violence, pushing them further away from health and HIV services.

Fearing possible legal consequences and disclosure to family member, many shun HIV services either in the traditional setting or through outreach work.

However, just as Abdul has said, HIV is not written on the forehead and it’s not a death sentence.

“You can still go anywhere you want and live a normal life as long as you are disciplined in taking your medication and doing what is right to keep yourself and everyone around you safe,” he pointed out.