Республиканский центр по профилактике и борьбе со СПИД Министерства здравоохранения и социальной защиты населения Республики Таджикистан
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HIV testing is a powerful tool for preventing the infection (interview)
Source: http://nc-aids.tj/
According to official statistics 470 new cases of HIV-infection were revealed in Tajikistan for the first six months of 2013.
Laboratory HIV test plays a key role in the diagnosis of HIV-infection. Early diagnosis of HIV-infection is very important for the timely conducting of appropriate treatment and taking preventive measures for maintaining health of People living with HIV, as well as effective prevention of further spread of the infection.
For learning more about HIV diagnosis and its relation to its prevention, we approached the Director of the National AIDS Prevention Center at the Ministry of Health of the Republic of Tajikistan, the candidate of medical sciences RUZIEV Murodali Mehmondustovich.
- Dear Murodali Mehmondustovich, what is the situation on HIV infection in the country?
- In the country for the first six months of 2013 specialists of AIDS centers' laboratories and other authorized medical institutions identified 470 new cases of HIV infection (HIV), among them 288 men and 182 women (828 new HIV cases in 2012 - Ed.). Since 1991, 5144 HIV cases were registered in total as of 1 July 2013. This is the cumulative number (total number of HIV cases identified between 1991 and 2013, as of 1 July - Ed.).
Diagnostics of HIV infection, in general, is a complex process based on data from laboratory, epidemiological and clinical examination. The laboratory test of blood called "HIV test" (test) plays the key role. We can talk about the presence or absence of HIV infection in a person only after receiving the results of the test.
Usually people are consulted before and after the test about the HIV transmission ways, HIV prevention methods, etc. Consultation and HIV testing are voluntary, confidential and also, at the request of an individual, anonymous - voluntary consultation and testing, or VCT (in some cases, in accordance with the law of the country "On HIV and AIDS Response" compulsory medical examination for HIV is prescribed - Ed.).
- What is the scale of the country's ongoing HIV testing?
- 453 831 persons were tested for HIV in 2012 in the laboratories of AIDS centers and other authorized medical institutions of the country, for the six months of 2013 – 271 059 persons were tested. To compare, during the whole 2010 only about 280 000 people were tested for HIV and 1004 new HIV cases were revealed, which is the highest number after the all time of monitoring and control of this infection in the country (1004).
- What is being done after the HIV infection has been diagnosed?
- People living with HIV (PLHIV) or HIV positive people (people with the HIV positive test - Ed.) are under dispensary observation of the AIDS centers' specialists. Dispensary observation in particular includes actions such as regular screening of patients for tuberculosis, conducting relevant laboratory tests, prescribing of antiretroviral therapy (ART - treatment against HIV - Ed.) for patients in the process of their observation in accordance with the recommendations of the World Health Organization (WHO), etc. This allows keeping health and ability to work among many patients for many years, and is also one of the effective measures in complex prevention of HIV.
- How it is done, could you please describe the latter?
- First of all, People living with HIV supervised by specialists of AIDS centers are usually well informed about HIV transmission ways and infection prevention measures, which they try to make the most of their daily life, including sexual. This is one of the essential factors to prevent HIV further transmission. Secondly, antiretroviral therapy given to patients (PLHIV) can significantly reduce the concentration of virus in their body, up to undetectable levels (in the laboratory test - Ed.), which is also an important part of the complex prevention of the further spreading of infection.
- Could you please provide more details about the place and role of diagnostics in the complex prevention of the infection?
- HIV testing, along with its task to identify the infection, which is being successfully performed is recognized as the world's powerful tool of preventing the latter. Let me explain this with some examples.
The following is the known fact from international sources on HIV infection - in real life, only about 40% of people (tested for HIV) from the total number of people who actually have this infection know about their disease. The remaining 60% generally don't suspect about presence of this infection at themselves for a long time until they are tested for HIV in connection with deterioration of their health or other reasons. But transmission of HIV from them to healthy people can take place (by injection, sexual or vertical way of transmission - Ed.) by mutual inobservance of the corresponding safety measures, for example when people don't use a male or female condom during sex (unprotected sex), etc. Against this background, as I said above the awareness of People living with HIV and their commitment to preventing the transmission of the virus is a strong factor against the further spread of infection.
It should also be noted that all people who go through VCT get information about HIV (transmission ways, prevention, etc.) independently of the HIV testing result. The HIV testing result in the vast majority of them is negative. This is a crucially positive factor in the infection response.
- Are there more examples?
- Mandatory regular testing for HIV in the country for all donors of blood and organs helps to prevent the transmission of infection through blood transfusion (transfusion of blood or blood products/preparations in medical practice - Ed.) and organ transplantation. HIV positive people are not allowed to be donors.
HIV testing conducted in the country for pregnant women can in case of detection of this infection in any of them effectively prevent the transmission of HIV from mother to child (prevention of mother-to-child transmission or PMTCT - a set of measures to minimize the risk of transmission of HIV to a baby during pregnancy, childbirth, and the postnatal period - Ed.). Prescription of ART to HIV positive women during pregnancy allows us not only to prevent most of the transmission of HIV to the child, but also significantly improve the health of the expectant mothers.
About 170 000 pregnant women were tested for HIV in the country in 2012 and more than 100 000 for six months in 2013. For comparison: in 2010, about 110 thousand pregnant women were tested for HIV. Abovementioned treatment and preventive measures are applied for all HIV diagnosed cases in pregnant women.
- After such prevention and birth of baby, how to determine whether he was born healthy?
- HIV testing helps in this also. Previously, identification of the infant HIV status (positive, negative), using an appropriate screening method of examination was possible only 18 months after the baby was born. Currently, in the diagnostic laboratory of the National AIDS Prevention Center in Dushanbe for early detection or exclusion of HIV in infants born from HIV positive mothers an examination technique called "Polymerase chain reaction" (PCR) is being applied. At the core of the PCR is detection of HIV RNA (RNA - ribonucleic acid - the hereditary material of the virus - Ed.). Diagnosis of HIV with application of PCR is possible in the first days after birth.
Early diagnosis of HIV in infants is very important because today early initiation of antiretroviral therapy after that is promising in terms of potential recovery of the child from the infection.
- Are there any cases of recovery from HIV in the world?
- Yes! It is a girl - a native of Mississippi (USA), born to HIV positive mother about three years ago. This was reported in the media. There are also reports of a functional recovery from HIV among adult patients. It should be noted that the facts of patients recovery from infection is largely dependent on the time of people's addressing to get tested for HIV (early detection), and also on the early initiation of ART after diagnosis. We could talk more about this in the next conversation.
Interviewed Numondzhon Abdukhamedov, Independent journalist
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Государственное учреждение "Республиканский центр по профилактике и борьбе с СПИД" Министерства здравоохранения и социальной защиты населения Республики Таджикистан www.nc-aids.tj