News 21/07/2002

Over 30 Maltese on HIV treatment

- Majority of cases homosexual/bisexual males

By Marika Azzopardi

At present there are 55 people who are HIV positive and who are visiting St Luke’s Hospital for regular follow-ups. Out of these 55 persons, 33 are on HIV specific treatment. The medication costs the taxpayer over Lm 150,000 a year. But if all the diagnosed individuals had to make use of the free treatment it would cost just under Lm 270,000 a year.

Dr Carmel Mallia Azzopardi is Consultant – Infectious Diseases at St Lukes Hospital. Talking to MaltaToday he explained the present situation in Malta. "Not all HIV patients require treatment but those who do not, are monitored regularly and closely. This ascertains the best time in which the patient needs to start treatment."

The majority of persons suffering from HIV infection in Malta are homosexual/bisexual men, a grand 65 per cent. The rest differ, some are heterosexuals, others are blood product recipients and only a couple are drug addicts. The average age group is between 30 and 40 years and 20 per cent of the infected persons are female.

"These statistics are particularly surprising since there is no apparent boom of drug users who are also HIV positive. If this were the case, it would be immediately evident since all addicts passing through Detox get checked out regularly. But we are just plain lucky not to have an explosion of HIV cases amongst addicts here but it only takes one infected person to transmit the disease like wildfire," Dr Mallia Azzopardi said. He pointed out that Hepatitis C is very common among Maltese drug addicts and this is a sure sign of needle sharing.

MaltaToday asked Dr Mallia Azzopardi about the distinction between AIDS and HIV and at which point does HIV become AIDS. "When the epidemic became known in the early 1980’s, medical knowledge was minimal. So, mainly for research purposes, a rigid distinction was made between HIV and Aids. But this was before effective treatment was available and nowadays, this distinction is not really suitable any more."

In fact, the lay person’s idea of an HIV sufferer is of somebody who has just become conscious of possessing the infection but is still relatively functional. The Aids victim is seen as a person at the end of his or her life, and suffering atrocious pain till the imminent end.

"This is really not the case anymore. At least in countries like Malta where HIV is controllable through medication. Here we have cases of well controlled HIV and very few with advanced HIV, but once the disease is kept under check, then it’s relatively ok."

The only method of keeping the illness under control is through medication, which is extremely costly. Everything is monitored closely, especially since each person requiring medication has to take at least three different medicines at a time, several times during a day. The cost of care of HIV patient on treatment is on average LM300 to LM400 monthly in medications excluding consultations, blood tests and hospitalisations.

The most important aspect of medication he stresses, is the regularity with which it is administered. Patients need to take medication orally, generally in capsule form. He stresses that strict monitoring is useful also in ensuring that these persons do take their medication at the prescribed intervals throughout the day, to ensure that viral resistance is not allowed to develop.

There are various reasons why a person may opt not to take prescribed medication. One reason is that once a person feels well, he or she does not continue the treatment. "This attitude could have disastrous effects since the infection is kept at bay through a constant bombardment of appropriate medication. If complete compliance is not maintained, emergence of resistance easily occurs, and then we get to the point where nothing works. And unfortunately it is very difficult to reverse advanced HIV." Another reason is that medication can have unpleasant side effects which people would understandably want to avoid.

Dr Mallia Azzopardi explains how prior to 1998 all the patients in his out patient clinic were dying people. "We have managed to change HIV from a fatal disease to a chronic disease. In fact, more than 60 per cent of all the persons undergoing therapy at present, hold a full time job, which is very positive indeed."

But what are the first indications that a person is suffering from HIV? There is usually a time interval of about seven to nine years between getting infected and developing the 1st symptoms ie a very long incubation period during which the HIV positive person looks and feels completely well BUT can still transmit the infection.The patient will start getting symptoms only after his or her immunity that is the ablilty to fight infection wanes below a certain level.

It generally starts off from a dramatic weight loss, skin rashes and oral candida. A person may go to his GP repeatedly for a series of infections and eventually get referred for in depth testing. The treatment available in Malta is very comparable to that used in of develop Here in Malta, we have one of the best treatments available, compared to the States and Europe. But unfortunately this is not the solution to the problem. The solution is nipping the problem in its bud and I feel that all our information campaigns seem to be having little if any effect." Although information campaigns are useful, it is disappointing to see that a lot of irresponsible sexual activity and drug abusestill take place. There is always the feeling, especially amongst the younger generation that" HIV does not concern me, I am not at risk".

And he hinted at the huge emotional problems which somebody diagnosed as suffering from HIV has to face. "Here we are not simply faced with patients, we are faced with human tragedies, which unfortunately have no solution."