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OB/GYN Editorial SEPTEMBER 2003
HIV… The Insidious Disease
In the late 1970s, many patients, especially younger males, presented
with adenopathy, fevers, weight loss, and oral thrush to the physician.
No definitive diagnosis was ever made and everything was attributed
to a probable "viral infection."
Physicians and patients
alike were confused. In the early 1980s, the diagnosis of human
immunodeficiency virus (HIV) and acquired
immunodeficiency syndrome (AIDS) came into being, and this in turn
set off tremendous research regarding treatment, etiology, prognosis,
etc, which we all know is still ongoing.
Today, we realize that
HIV is not just a disease of gay males. The disease has spread
beyond the confines of a particular sex
or race. It is a disease of humanity and all persons, including
women, should be aware of this.
Many people, however, are under
the impression that they will not be infected with the disease
because they are female and are not gay. Untrue! Many males are
bisexual, and many, unfortunately, do not practice safe sex; therefore,
the spread, infection, and
transmission of HIV are still rampant. Females, just as males,
should have an HIV initial screening test called an enzyme-linked
immunosorbent assay (ELISA) done on a regular basis, especially
if they are sexually active. Awareness is the key to avoidance
and longevity.
At this time, there is no cure for HIV. True, there
is no cure for diabetes or hypertension either, but HIV is of a
different
caliber. There is a misconception that, because of research and
the introduction of new antiviral medications (protease inhibitors,
nucleosides, and non-nucleoside reversed transcriptase inhibitors),
the disease is totally suppressed. Wrong! The disease is kept "at
bay," but often only for limited periods as resistance to
the medications often develops due to noncompliance with taking
medications as well as indiscriminate sexual activity.
The most
important aspect in avoiding contracting the condition is practicing
safe sex. Education, instruction on condom use (female
and male condoms), as well as the use of a dental dam during
oral sex are of vital importance. The HIV may be resistant to the
medication
the partner is on, hence a condom always must be used. Using
a contraceptive pill is not protective against contracting this
condition
nor, in fact, any other diseases such as sexually transmitted
diseases (eg, gonorrhea, syphilis). If both partners (female and
male) are
HIV positive, condoms should still be used to avoid secondary
and re-infection.
If a woman is pregnant and HIV positive, there is
a chance the baby will be infected, and specialized prenatal care
is therefore
essential. All females of child-bearing age—in fact, all
males and females who are sexually active—should be educated
about this condition and prevention cannot be over-emphasized.
Human
immunodeficiency virus is a chronic viral condition, eating away
at the body tissues. It is important that we, as clinicians,
take the extra time to discuss HIV with all patients. Everyone
is at risk!
The media has helped tremendously in spreading information
about HIV. The old idiom, "a stitch in time saves nine" must
be applied to this condition.
In closing, we can say that no one
is immune, so let's spread
the preventive word as we do for heart disease and other conditions.
Leslie Trope, MD
Advisory Board Member
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