Q. How do you diagnose this infection?
A. This usually involves some blood tests. The technique used is often the ELISA test which can be done in many clinics and hospitals throughout the country. The results come back usually within one or two days and it tends to be very sensitive (therefore with the possibility of false positive results). Because of this, testing should always be done with counseling because interpretation of the results can sometimes be difficult.

Q. How would I know if I have HIV?
A. The blood test would be the way to know as described above. However, I think it is important that one should asses whether actual exposure has occurred (risk behavior e.g. unprotected sexual intercourse, sharing of needles, etc.)

Q. Does everyone who has HIV infection die of this disease?
A. 95% of patients with HIV will gradually progress to AIDS (the terminal stage of HIV infection). This process may take anything between three to twelve years depending on the individual. However, there is a small group of about 1 - 2% of HIV positive patients who do not appear to progress/or progress very slowly (long term non-progresses) and they appear to sometimes remain asymptomatic for more than 15 years. However, if one were to follow them up long enough they may one day still land up with AIDS.

Q. How do you get infected with this disease?
A. The three main ways of HIV transmission are: unprotected sexual intercourse, (both gay/straight), sharing of needles among IV drug users and infected mother to her unborn child.

Q. Is it true that the HIV virus kills the white blood cells? If it is so, would an anemic patient have more defense capabilities compared to the average person?
A. The function of the white blood cells is often linked to the immune system of the individual. Whereas, anemia is actually a deficiency of hemoglobin which is found in red blood cells. So, unfortunately your above theory may not work in clinical practice.

Q. What is the percentage of babies getting infected from HIV-infected mothers?
A. 30% without treatment.

Q. If a person has sexual intercourse with an infected female, what is the chance of him getting the disease?
A. The risk of vaginal intercourse without protection may vary between 0.1 to 0.01%. However, there are many other factors which can increase transmission including the presence of genital ulcers, the type of sex act actually performed, sex toys etc. etc.

Q. Are there any other methods of spreading HIV besides sexual intercourse, inheritance and blood transfusion?
A. As mentioned before there is a 30% chance of transmission from an infected mother to her unborn child. You are right, transfusion using contaminated blood will certainly transmit the infection. However, in many developed countries including Malaysia all blood used in blood banks is screened for HIV.

Q. What would be the average life span for a person who has been diagnosed with HIV when he/she was an infant?
A. Children infected with HIV tend to do poorly compared to the adults. While the adults may survive more than ten years without any symptoms, many children actually die before the age of six without treatment. However, there are some fortunate children who actually survive until their teenage years but their numbers are small.

Q. The blood tests only tell you after your body has produced the HIV antibodies. How do you find out whether you got the infection immediately after having sexual intercourse with a prostitute?
A. Be patient. You have to wait for sometime even if you use the newer (and usually used in research) antigen test you will still have to wait for a few weeks.

Q. Is the female at risk when she does have sexual intercourse without a condom but she is on the pills?
A. The pill won't work. The issue here is not contraception, the issue is 'barrier protection'. Therefore, the condom works while the pill doesn't.

Q. Can HIV be transmitted through the act of oral sex or French kissing?
A. Yes. However, the risk is significantly lower than anal or vaginal intercourse. In oral sex, the person performing the act runs the higher risk but some couples use the oral dam which acts as a barrier or oral sex with a condom. French kissing has relatively low risk unless there are lesions or cuts in the oral cavity.

Q. Why do some people progress rapidly to AIDS while others take a long time?
A. There are two main factors for this. Firstly each individual responds differently to the virus and the immune response mounted against the virus after infection varies a great deal. Some people can suppress the virus much better than others and therefore, they intend to progress much slower. However, they are still HIV+ and they can still transmit the virus. Secondly, the viral strains may also be one that is less pathogenic and therefore does not destroy the immune system as rapidly.

Q. What kind of treatment do HIV-infected pregnant women receive so that their child would not suffer the same fate?
A. We can provide some anti-HIV drugs given to both mother and to the newborn child (examples AZT and Nevirapine) which can effectively reduce transmission from mother to child by 50 to 66%. For your information, our Ministry of Health is providing free AZT for all HIV infected mothers to prevent their babies from getting infection.

Q. Do condom protect one completely from getting AIDS if one practice casual sex often?
A. The efficacy of the condom is dependent on the quality of the condom itself as well as the technique of putting on the condom. However, the studies suggest that the efficacy of STD prevention may be anything between 90 to 99%. Although I agree with you that it does not completely remove the risk of HIV infection certainly if sexual intercourse is taking place with an 'unknown or uncertain' partner some protection is better than no protection.

Q. Would women with woman condoms get AIDS if they practice casual sex often?
A. Female condoms will also reduce HIV transmission. However, the issue is availability (not easily available) the cost is much higher than the male condoms and some of them can be bit 'noisy'. Yes, it will certainly reduce infection.

Q. Based on your answer, blood transfusion or sharing of needles by drug users is known to transmit HIV. Why can't mosquitoes or lice be vectors of transmitting HIV since they do carry other diseases through their bites?
A. We can answer this question in two ways.
1. There has been no documented cases of people infected from insect bites. If indeed mosquitoes could transmit the virus the rates would be higher than our dengue rates in Malaysia and the global rates of HIV will be as high as the malaria infection rates.
2. Some researchers have found that enzymes in the digestive tracts of some of these insects may actually hamper the fitness of the virus.

Q. How come HIV virus can be transmitted outside the body? like for instance thru a needle?
A. HIV transmission requires a very direct route for eg. in sexual intercourse there should be penetration and in drug users there should be sharing of needles with contaminated blood inside. I think that you are asking me whether the virus can survive outside the body for a prolonged period of time. The answer to that question is no, however, I have to qualify that statement. If the blood is dried and coagulated the risk of transmission is significantly reduced whereas the risk of transmission is much higher if the blood is still fresh.

Q. Dr Bella, you mean to say that a person has only 0.1 to o.o1% of getting AIDS if he has intercourse with an infected person. What about Anal sex ,what is the chance of infection then?
A. Anal intercourse has a higher risk and it can vary between 1 to 10%.

Q. I have read articles saying some HIV positive people use needle to poke other people to infect them with HIV is this true?
A. In theory this route of transmission is possible. However, this is not something that happens often and if it does it is already a criminal act and should be reported to the police. The large majority of HIV infected people are very 'normal' and do not behave in a manor you have described above. In fact, they suffer more from our discrimination and isolation.

Q. What's your advice to married couples where one of the partners is HIV positive. Can they continue having a healthy "protected" sex life?
A. Good question. The answer is yes. However, sexual intercourse should be a decision made by both of them with all the risks considered.

Q. What is the life expectancy of people diagnosed HIV positive?
A. The average life expectancy is about 10 years.

Q. Does using an antiseptic douche to vagina before sex help to reduce the risk of infection?
A. That has been tried but the data is very conflicting. It is not recommended as a routine prevention method.

Q. Dr Bella, how does one have oral sex using a condom?
A. The person (the man) who is being serviced wears the condom.

Dr Christopher Lee,
Infectious Diseases

Q. What about French kissing, would that transmit the virus?
A. No it will not transmit the HIV virus.

Q. I understand that the HIV virus is present in the saliva of an infected person. However, I cannot understand why a person would not be infected if he engaged in French kissing with a infected person. Could you please explain.
A. If there is an ulcer or a cut in the skin inside the mouth, there is a slight chance that the HIV virus.

Q. I gather that the HIV virus is present in body fluids in an infected person, what is the risk of a mosquito biting this person and transmitting to the next ?
A. There is no risk at all of a mosquito biting and transmitting HIV from an infected person to another person.

Q. Could you explain a bit more about the mosquito bite as I gather the blood ingested by the mosquito might contain the HIV virus?
A. The virus wouldn't have the ability to replicate in a mosquito's body. Therefore, transmission is not possible.

Q. I have a friend who has AIDS and is married. He wants to have children but at the same time would not like to pass the infection to his wife and his future children. What advice would you give?
A. I would recommend that your friend seek consultation from his physician regarding the matter of having children. Once he has sexual intercourse with his wife, there is definitely a chance that she will become infected. With regards to the future child, there is a 30% risk that the HIV infection will pass on to the child, if the wife becomes infected.

Q. Where else could my friend go to seek advice regarding having children if I am HIV infected? You recommend seeing a physician but I find that a lot of them are really not knowledgeable about HIV/AIDS infection.
A. I would recommend that the person seek advice from an Infectious Disease Physician or any doctor who has been handling a lot of HIV patients.

Q. If an AIDS infected women gets pregnant with a baby. Is there any way in which the baby would not become infected?
A. The mother has to go on AZT/Zidovudine from the second trimester to reduce the risk of transmission. However, the transmission rate is reduced by 70% by taking this drug. In Malaysia, the pregnant mother is given the drug free of charge during pregnancy.

Q. As you mentioned, only 70% of HIV infected pregnant woman are prevented from transmitting the disease to the fetus, if there go on drug treatment in the second trimester. What do you advise regarding the remaining 30%?
A. I think that you have misunderstood the previous question on this subject. The risk of transmission to the baby is reduced from 22.6% to 7.6% if the mother goes on treatment.

Q. Why is a woman more likely to be infected with the HIV virus compared to a man if she has sexual intercourse with an infected partner?
A. Gender does not affect the rate of transmission of HIV. Some of the factors that will affect the transmission of HIV are:
1. How weak is the immune system of the patient. i.e. how high is the viral load and how low is the white cell count.
2. Presence of any other STD's (sexually transmitted diseases)

Q. How many children are infected with HIV/AIDS in Malaysia since the first case was noted? How well do the infected children cope with the side effects of the drugs they are given?
A. Up to January 2001 from 1986, there are 297 recorded cases of children with HIV infection including AIDS. Definitely there would be some side effects but we treat them symptomatically.

Q. Do infected children get their treatment and medications free of charge in Malaysia?
A. Yes, they do.

Q. My friend went to Thailand and engaged a prostitute. He is now very worried whether he might get HIV infection. What is your advice to him?
A. He should have a HIV test done and make sure that he has safe sex next time using a condom.

Q. What are the latest drugs in the pipeline that could make a difference to people with HIV in terms of lesser side effects or reduce the amount of medications that have to be taken?
A. There are a few drugs in the pipeline. An example of a drug that is taken once a day is Efavirenz. However, it must be taken in combination with two other drugs.

Q. One of my friends is taking care of his brother who is dying of AIDS, What is the risk of him getting the disease especially if he comes into contact with his brother's blood or saliva?
A. He will not get infected unless the caregiver has a cut or wound that has come into contact with the blood of his infected friend.

Q. Does the urine of an AIDS person contain the HIV virus?
A. Yes, it does. However, you would not get infected by touching the urine. The HIV virus does not transmit this way.

Q. Why in some cases a person who is infected with the HIV virus does not develop AIDS for many years?
A. Once the HIV virus enters the body, it begins to replicate and destroy the white cells (CD4 cells) and once the CD4 drops to a certain value a person then has entered the stage we consider as AIDS.

Q. How effective are the drugs available at present in arresting HIV? what is the life expectancy in treated and untreated cases?
A. The drugs will increase the white cell count and reduce the viral load to undetectable levels but it will not eradicate the virus. Combination drug therapy has only been used for the past 6 to 7 years. The majority of patients on this therapy are doing well.

Q. How does one manage a person who is dying of AIDS with regards to nursing care as well as the emotional aspect?
A. From the emotional aspect, there are lots of NGO's that the patient or the caregiver can talk to e.g. Pink Triangle, Malaysian Aids Foundation. For nursing care, it might be good to speak to your healthcare provider who could give you advice on management and nursing care of the patient.

Q. How does the presence of other STD infections influence the likelihood of a person getting the HIV infection?
A. When there is STD's, you are likely to have ulcers or breaks in the skin which allow the HIV virus to enter the body.

Q. What are some of the concerns that a person might have when they have discovered that they are infected with HIV?
A. First of all, they worry about whether there is availability of treatment or cure. They often don't know what to do because of the 'shock.' They often are concerned whether they can live long or live a healthy life and they might worry that they will lose their job if people find out that they are HIV positive. They will also worry about losing their partners or loved ones. They will start seeking all sorts of alternative or traditional medicines or start listening to all sorts of unestablished treatment possibilities.

Q. Why is pre and post-test counseling necessary?
A. Pre and post-test counseling is used to reduce HIV transmission and to provide the affected person with adequate information on HIV/AIDS. Also, to help them understand transmission.

Q. What advice can be given to HIV infected people that would quell their concerns?
A. They can seek advice from Doctors, NGO's providing the HIV support and counseling and access HIV web pages and chat rooms such as this to help quell their concerns.

Q. What kind of counseling or advice could be given to a person who has had sex with another who happened to be infected with HIV, unknown to him, assuming that a condom was used?
A. The person should go for proper pre-test counseling followed by an HIV test. Although the condom was used it is still not 100% guarantee that the person involved would not be infected.

Q. Counseling requires cooperation and openness from the patient. What methods can a doctor use to achieve this?
A. Being a doctor, we have to be patient, be a good listener and show our sincere care and concern in order to gain the patient's trust and cooperation. Confidentiality is another important issue as well.

Q. In the course of your counseling you will have to tell the HIV infected person that eventually he is going to die, How do you advise him to make his remaining days meaningful?
A. With the availability of effective treatment regimens (combination therapy), we are seeing more and more HIV infected patients able to live a normal and healthy life. We always advise them to go on treatment when medically indicated in order to maintain a good quality life.

Q. Stigmas tend to be associated with HIV sufferers to the extent that many people actively avoid any form of physical contact with them in fear of catching the virus. What are some of the ways that can be used to better educate the masses in HIV transmission?
A. Public education on HIV and also sex education will have to be intensified.

Q. What methods of counseling are employed, is it a one to one or group counseling? Are other methods such as a film or audio-visual means also being used?
A. It is usually a one to one counseling session ensuring that confidentiality can be maintained. Audio-visual means are not often used but can surely assist in the counseling if time permits.

Q. What kind of counseling needs to be given to families of HIV sufferers?
A. The spouse or family members of the HIV infected persons need to be counseled for HIV/AIDS, including HIV testing, transmissions, preventions and also the care of the HIV infected partner or family member.

Q. What is the risk of an HIV person passing the infection to his or her spouse?
A. With unprotected sex, transmission is likely to happen. With protected sex, for example using condom, this risk can be reduced significantly.

Q. How good is wearing a condom in protecting a person from getting HIV/AIDS?
A. It is not 100% safe but this is the only effective protective measure for those who are sexually active.

Q. Is there a method to detect whether a person has AIDS before HIV antibodies are present in the blood?
A. HIV antibodies will be present in the blood before AIDS develops. AIDS is the advanced stage of HIV infection.

Q. How many types of aids virus are there?
A. Basically there are two main types: HIV-1 and HIV-2.

Q. What is the likelihood of a person getting AIDS if he or she has sex with an infected person, in terms of percentage?
A. With unprotected sexual activity following 1 occasion of receptive anal intercourse the rate of infection is between 0.1% to 3%. Following receptive vaginal intercourse the rates of infection is 0.1% to 0.2%. Whereas for insertive vaginal intercourse rates of infection after one exposure are 0.03% to 0.09%. With multiple sexual exposure the risk of transmission is much higher. It is worse with multiple partners and those with HIV infection but untreated. With multiple sexual exposure the risk of transmission is much higher. It is worse with multiple partners and those with HIV infection.

Q. I understand that HIV infection attacks white blood cells causing the sufferer to eventually die from other diseases that would otherwise be fought off. Why is this so?
A. After the white blood cells have been attacked by the HIV virus, a person's immune system will be compromised. He won't be able to fight against bacteria or viruses that usually don't result in disease in the normal person. This is called opportunistic infections.

Q. Can HIV infection be transmitted by other means beside sexual intercourse?
A. Yes. In Malaysia sharing of needles for intravenous drug use is in fact the most important mode of transmission. Contaminated blood transfusions is another mode of transmission but is rare because all of the blood products are screened for HIV before being used in Malaysia.

Q. There is recent medical news that a vaccine is close to being developed for HIV. What are the obstacles to an HIV vaccine being developed?
A. The main obstacle is that there are so many different strains of HIV virus. The vaccines may be effective to one strain but not the other.

Q. What are the opportunistic infections that you mentioned?
A. The common ones include: oral thrush due to Candida infections, pneumocystis carinii pneumonia, cerebral toxoplasmosis, tuberculosis, Cryptococcus infection, histoplasmosis, etc.

Q. What are some of the drugs currently available that help to limit the spread of HIV to a person?
A. To limit the spread of HIV to a person we do not have any specific drug as yet. However, for HIV infected persons we have many antiretroviral drugs available. They have been proven to be effective and useful for the control of HIV infections and the immune reconstitutions.

Q. How many cases of HIV infection have been reported so far in Malaysia?
A. From 1986 until July 2001, we have cumulative reported HIV cases of 41,503. Among them, 5,450 were reported to have AIDS.

Q. Does putting donated blood in the refrigerator kill any HIV virus present in the blood?
A. No.

Q. If a person gets accidentally pricked by a needle that has been used to take blood from an AIDS patient, what are the steps that must be taken?
A. This usually happens in a healthcare setting. This incidence has to be reported to the person in charge for assessment of the risk of transmission and depending on the risk of transmission post exposure prophylaxis can be provided in order to reduce the risk of HIV infections.

Q. It only takes a prick of a needle that contains HIV-contaminated blood to cause transmission to occur. Why is the HIV virus is so virulent?
A. The risk of transmission following a single needle prick injury was reported to be around 0.3%.

Q. What are the chances of an HIV infected person getting AIDS and how long does it take before he will get full blown AIDS?
A. It depends on the individual and the progress of the infection. In general, an HIV infected person would develop AIDS after 6 to 10 years of infection. There are a minority of patients who only develop AIDS after 15 years of infection. They are called the long-term non-progressor. There is another group who develops AIDS very rapidly i.e. within 3 years or so and they are called the rapid progressor.

Q. Is there any case of a person who is HIV infected but never develops AIDS?
A. This rarely happens.

Q. How is it possible that certain people can be HIV-carriers but suffer no ill effects throughout the duration of their lives? Are they naturally immune?
A. No. They do not suffer the ill effects because the immune system has not been damaged badly as yet. But with time, with further deterioration of immune functions they will eventually develop symptoms or diseases.

Q. Please explain why a mosquito bite cannot transmit the disease?
A. HIV virus does not replicate in a mosquito.

Q. What are the drugs that are currently available to treat aids?
A. We have 3 main classes:
1. protease inhibitors (PI),
2. Nucleoside Reverse Transcriptase Inhibitor (NRTI)
3. None Nucleoside Reverse Transcriptase Inhibitor. Within each class we have many choices of drugs.

Q. I have heard that tests have been conducted on individuals who have been infected with HIV, but have suffered no ill effects in order that a cure can be found. What is the latest breakthrough made in the fight against HIV?
A. There is no new breakthrough as yet but we have effective and safe drugs to help control the HIV infections and disease.

Q. How long does the treatment last?
A. Treatment for HIV infections is lifelong.

Q. How long before a vaccine is developed to fight aids?
A. We are still waiting for the breakthrough.

Q. What are considered to be the origins of HIV?
A. It is postulated that HIV originated from primates (African green monkey, chimpanzee (HIV-1), sooty mangabees (HIV-2)).

Q. How could it be possible for monkeys to transmit HIV to humans unless someone was doing something that they should not have been doing?
A. We do not know. We are yet to find out the answer! It was postulated that the infection could possibly occurred through close contact with the primates.