Then, probably among the youngest, those who are going to become sexually active, we don’t talk enough about STIs in general. (Editor’s note: sexually transmitted infections) and prevention. When we see all the hay that was made for EVRAS (Editor’s note: education for relational, emotional and sexual life) and which is in my opinion something useful, provided by professionals and adapted to the age of the public, I am surprised because, yes, there is education to be done around sexual life. Today, we talk about HIV less and that is undoubtedly for the good too – it means that it has become part of existing pathologies, and it also means that there has been progress in terms of of discrimination against sick people – but by talking less about it, we do not reach the target audiences.
Do we still need to remember how HIV is caught?
Yes. The virus is transmitted through blood, sexually and from mother to child. In the first case, it is caught through needle exchange. This is where all the prevention that can exist in large cities like Liège or Verviers comes in, around the distribution of clean equipment. There is important work to be done with social actors on the ground.
Then, in mother-to-child transmission, there has been a strategy in place for years: a woman who gives birth undetectable will not transmit HIV to her baby. In addition, under certain conditions, breast-feeding is now authorized. That doesn’t mean that all women do it, but the fact of saying that now they have a choice is very nice.
Finally, in prevention linked to sexual transmission, hetero or homosexual, there is the wearing of a condom which we can never emphasize enough; there is the fact of treating HIV-positive people as quickly as possible since undetectable means untransmittable; and there is the famous PrEP.
Is this means of prevention new?
It has been around for several years but we don’t talk about it much. It is a treatment offered to people who have multiple partners, without always protecting themselves optimally, as a prophylaxis, therefore before sexual intercourse. There are two types of schedule: either on demand (2 tablets before intercourse then a 3rd after intercourse and a 4th again after); or continuously (you take your medication every day). There is a whole follow-up organized around this treatment and around screening for other possible STIs.
I am really delighted to be able to offer this treatment in Verviers from now on because until now patients from the Verviers region had to go to Brull, in Liège, to benefit from it.
Once the virus is there, how does it spread through the body?
The virus will attack CD4 lymphocytes. Our immunity is effective thanks to the large family of white blood cells which are the soldiers who fight, among other things, against infections and, in these blood cells, there are these CD4 lymphocytes. So why is AIDS not cured? Because it is an RNA virus which, in order to multiply, needs to enter the nucleus of lymphocytes. After this multiplication (replication), it will then infect other cells. What causes AIDS after the infectious manifestation is the significant drop in CD4 counts. These infected lymphocytes will be recognized by the rest of our immunity as infected and it will destroy them. So, after opportunistic diseases.
Today, even if the disease is discovered late, we really have an arsenal of treatments. We have antiviral treatments which are extremely effective and powerful, and can reduce the viral load quite quickly while being well tolerated. We also have all the treatments to counteract the manifestations linked to AIDS, but we must keep in mind that the sooner we know that we have HIV, the better.
Hence the importance of screening?
Of course. What is important to say is that once you know you have an STI, it is very useful to screen for all other STIs, including HIV. Then, when we are a caregiver facing a patient who has an STI, we must be able to assess the risk that the person has, in the future, of being exposed to another STI. It requires a lot of openness.
Because the disease remains taboo?
I think HIV remains taboo, that’s for sure. When I said that there is less discrimination, that is true and not true. It remains a hidden illness, with a risk of value judgment. What remains complicated is talking about sex or sexuality, for the patient or for the doctor. People are very uncomfortable talking about this. And it’s sometimes difficult for some people to answer honestly and openly.
What are the expected medical developments in relation to AIDS?
Healing is still not happening at the moment, it must be said again.
In recent years, there has been the advancement of injectable treatments, with the main constraint of having to come to the hospital every two months. But, at the moment, there are molecules under study which would allow injections twice a year. This would be revolutionary for people’s quality of life. In terms of PrEP, in Belgium, injectable treatment is still not relevant because there are constraints linked to injections and cost constraints.
“We need to talk about all STIs without being moralistic because it’s useless”
Christelle Meuris, HIV is not the only sexually transmitted infection (STI). What are the others?
Other STIs that require vigilance are gonococcal, chlamydia trachomatis and syphilis. The three are caught by muco-mucosal contact, therefore oral contact or simply during foreplay. The condom will cover a large part of sexual intercourse but, as I often say, you don’t wrap your whole body in a large plastic bag.
And where it is worrying, in reality, is that we see that both men and women are affected and mainly those under 49 years old. And these infections can have significant consequences in terms of fertility.
Are there any symptoms to keep an eye out for when getting tested?
It can cause urinary symptoms so it can burn or sting when you urinate. It can cause purulent discharge, especially in men. Women can also have other symptoms of salpingitis. (Editor’s note: inflammation of the fallopian tubes)of cervicitis (Editor’s note: inflammation of the cervix). There, we will have pain in the lower abdomen or pain during sexual intercourse.
And as far as syphilis is concerned, it can cause almost anything: canker, skin rashes,…
If we realize that something is wrong, is the screening a blood test?
For syphilis, it is done by blood test, yes, and for the other two, screening is done by smear or by analyzing urine. And you should know that smears can be done by yourself, for both men and women.
We must also remember that there is herpes against which we do not know much and papillomavirus for which there is an effective treatment, via a vaccine. It has been there for more than 20 years and it has a clearly demonstrated effect, with a reduction in the incidence of cervical cancer but also precancerous lesions. For 2-3 years, it has also been offered to young boys. This is a very good thing. And it is very important to remember, in this era where people are reluctant to be vaccinated, that there are only two vaccines that protect against cancer: the one against hepatitis B administered from birth and the one against the papillomavirus.
I know that we are talking here about a vaccine to be administered to young people, to teenagers who are not yet old enough to have a sexual life, and it is sometimes complicated for parents to think about that but we know that we become infected in the first years of sexual life and we do not know who will develop cancer or not; who will clean their virus alone or not. So I think this vaccine is really a big step forward.
We talked about the difficulty sometimes of talking about sexuality, but is it important, crucial, to leave room for dialogue with loved ones, a doctor, an association?
Yes, definitely. I think you need a lot of openness to discuss all that. For the person to feel confident, the caregiver must say that he or she is not there to judge but to care for, to prevent. Generally, when you approach things like this, people open up little by little. It’s important to talk about this like other pathologies, without being moralistic because it’s useless. Because for me, the most beautiful medicine is preventive medicine. For example, some doctors do not welcome PrEP, but this preventive treatment ultimately costs less than treating a patient who has the HIV virus and it is also less burdensome to take this treatment than to live with HIV.
