Thu May 17 21:09:54 SGT 2012  
SHIM CLINIC
STD CLINIC SINGAPORE™
168 Bedok South Avenue 3 #01-473
Singapore 460168
Tel: (+65) 6100 7446
Fax: (+65) 6449 7446
24hr Answering Tel: (+65) 6333 5550
Web: www.ShimClinic.com 		Opening Hours
Monday to Friday: 9 am to 3 pm, 7 pm to 11 pm
Saturday & Sunday: 7 pm to 11 pm
Public Holidays: Closed
Last registration: half hour before closing time.
Walk-in clinic. Appointments not required.
Bring NRIC, Work Pass or Passport for registration.
If for STD testing, hold urine 4 hours before arriving.

HIV Risk | Shim Clinic, STD CLINIC SINGAPORE™
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Summary

HIV Risk | Shim Clinic, STD CLINIC SINGAPORE™: HIV risk factors/assessment/reduction clinic, Singapore. Private and confidential service. Definitions, references, and latest news.

Description

If you have been exposed to HIV in the last 72 hours, early HIV PEP (post-exposure prophylaxis/prevention) treatment can stop you from getting infected with HIV.

Table of Contents

Note: With the exception of the Western Blot test, the antibody or antigen test is usually a HIV ELISA test

HIV risk

HIV Risk Statistics (chances of getting HIV)
HIV Risk Factors HIV Transmission Probability
Needle stick injury3 1/300
Receptive anal intercourse4 1/100
Receptive vaginal intercourse5 1/1000
Insertive vaginal intercourse4 1/2000
Insertive anal intercourse4 1/2500
Receptive fellatio with ejaculation4 1/2500
Sharing needles6 1/150

As in a game of russian roulette, an infection could occur at the first exposure.

References

  1. Cardo DM, Culver DH, Ciesielski CA, et al. A Case-Control Study of HIV Seroconversion in Health Care Workers after Percutaneous Exposure. N Engl J Med. 1997;337:1485-1490.
  2. Katz MH, Gerberding JL. Management of occupational and nonoccupational postexposure HIV prophylaxis. Current Inf Dis Reports. 2002;4:543-549.
  3. Gerberding JL. Prophylaxis for Occupational Exposure to HIV. Ann Intern Med. 1996;6:497-501
  4. Vitinghoff E, Douglas J, Judon F, et al. Per-Contact Risk of Human Immunodificiency Virus Transmision between Male Sexual Partners. Am J Epidemiol. 1999;150:306-311.
  5. Peterman TA, Stoneburner RL, Allen JR, et al. Risk of Human Immunodeficiency Virus Transmission From Heterosexual Adults With Transfusion-Associated Infections. JAMA. 1988;259:55-58. [Erratum. JAMA. 1989;262:502]
  6. Kaplan EH, Heimer R. A Model-Based Estimate of HIV Infectivity via Needle Sharing. J Acquir Immune Defic Syndr. 1992;5:1116-1118.
HIV prevention / HIV PEP (post-exposure prophylaxis) treatment can prevent you from getting an HIV infection, and turning HIV positive.

Individuals are eligible for HIV PEP Treatment if all the following criteria are met:

  1. less than 72 hours has elapsed since exposure;
    and
  2. the exposed individual is not known to be HIV infected;
    and
  3. the person who is the source of exposure is HIV infected or has unknown HIV status;
    and
  4. mucous membrane or non-intact skin was exposed to a potentially infectious body fluid;
Prompt antiviral therapy may reduce the risk of HIV transmission by as much as 80%.

For optimal efficacy, antiretroviral therapy should be started as soon as possible, ideally within 1 hour of exposure. So that you can remain HIV negative.

The medications and dosages are the same as those used for lifelong treatment of HIV patients. However, for HIV PEP treatment, it is taken for only a month.

Drugs commonly used in HIV PEP:

References Kaposi's sarcoma Remember, there is no HIV cure.

HIV is the abbreviation for the human immunodeficiency virus, which causes the acquired immunodeficiency syndrome

HIV symptoms which may present in acute HIV infection:

These are nonspecific symptoms and can present with other infections; consequently, they are unreliable indicators of HIV infection.

HIV Test

The HIV window period is the time from HIV infection until a HIV Test can detect any change. Within the HIV window period, the HIV Test would be negative. During this period, the HIV viral load is extremely high, thus making the person highly infectious.

OraQuick® HIV Test Kit / HIV rapid test cost/price is S$60/=. No additional consultation fees are charged if the clinic attendance is only for this test.

Window
period 		Test Notes Cost /
Price
2 weeks HIV DNA test
  • A HIV NAT (nucleic acid test) for HIV-1 proviral DNA
  • A HIV PCR (polymerase chain reaction) test. Method: Proviral DNA Polymerase Chain Reaction (Roche Amplicor HIV-1 DNA Test, V1.5) This test uses primers SK145 and SKCC1B to define a sequence of 155 nucleotides within a highly conserved region of the HIV-1 gag gene.
  • HIV window period can be as short as 10-12 days
  • Usually used for the early diagnosis of HIV infection in neonates born to HIV+ mothers. As maternal antibodies circulate in the child for several months, the HIV antibody test would be positive.
  • Patient to arrive at the clinic before 10am (Monday to Friday only)
SG$752/=
1 month HIV p24 antigen test
  • A HIV antigen test that tests for the HIV p24 antigen, which appears in early infection, before the appearance of HIV antibodies. But later declines when the HIV antibodies begin to appear.
  • Usually packaged with the HIV-1/2 IgM/G antibody test, to becomes a 4th generation HIV ELISA test
SG$48/=
3 months OraQuick® SG$60/=
3 months HIV blood test most commonly sent to the lab. SG$12/=
HIV
confirmation 		HIV western blot test SG$275/=
HIV
follow-up 		HIV RNA test
  • A HIV NAT (nucleic acid test) for HIV-1 RNA of the free virus, giving the HIV viral load
  • A HIV PCR (polymerase chain reaction) test. Test Method: Abbott Realtime HIV-1
  • Usually used to monitor the progress of HIV+ patients on treatment.
  • Patient to arrive at the clinic before 10am (Monday to Friday only)
SG$717/=

References

CD4 count

  • Used in HIV follow up management
  • Cost SG$169/=
  • Results return in 1 week.
  • CD8 count is also available separately at the same price.
TORCH

TORCH complex is a medical acronym for a set of perinatal infections (i.e. infections that are passed from a pregnant woman to her fetus), that can lead to severe fetal anomalies or even fetal loss.
Other agents are:

Sexual risk (of STD/HIV/pregnancy), and what you can do before and after exposure.

TimelineEvent / Available resources
Before exposure
STD / HIV exposure Unsafe sex / unprotected sex:
0-72 hours
2 weeks
1 month
  • HIV p24 antigen test
3 months
  • HIV rapid test will be positive in 97% of infected individuals
    • HIV test cost is SG$60/= (HIV test only)
    • Oral fluid or finger prick blood sampling.
    • Results in 20 minutes.
  • STD testing
6 months
Anytime
  • Full/total/complete STD testing:
    • Men who practice insertive sex SG$497/=
    • Women who practice vaginal sex SG$737/= (includes Digene® HPV DNA & ThinPrep® test)
    • Either sex practicing anal sex SG$697/= (includes Digene® HPV DNA test)
    • Other variations - discuss with the doctor.
    • Hold your urine in your bladder for at least 4 hours.
  • STD treatment when STD symptoms appear.
  • Genital warts treatment/removal/cure

If you have been exposed to HIV in the last 72 hours, early HIV PEP (post-exposure prophylaxis/prevention) treatment can stop you from getting infected with HIV.

References

Latest News

Namibia: Poly Hosts HIV/---- Awareness Campaign
Wed, 16 May 2012 13:41:02 +0100 | AllAfrica News: Health and Medicine
[New Era] Windhoek - The Polytechnic of Namibia (PoN) last week held its two day 16th HIV/---- and Alcohol Awareness Campaign under the theme: No Youth No Future. (Source: AllAfrica News: Health and Medicine)

South Africa: Resubmit Proposals for Sex Actually 2012
Wed, 16 May 2012 09:12:47 +0100 | AllAfrica News: HIV----- and STDs
[Biz-Community] Drama for Life is requesting artists to resubmit proposals for Sex Actually 2012. This is due to technical problems on the website. Drama for Life apologises for the inconvenience and has consequently extended the entry deadline to 21 May 2012. (Source: AllAfrica News: HIV----- and STDs)

Nigeria: 'HIV/---- On the Increase in Abia'
Wed, 16 May 2012 09:08:36 +0100 | AllAfrica News: HIV----- and STDs
[Daily Trust] Umuahia - Project Manager of the Abia State Agency for the Control of HIV/---- in the state, Dr Sam Ohaeri yesterday said the HIV/---- prevalence in the state has increased from three per cent to almost ten per cent. (Source: AllAfrica News: HIV----- and STDs)

Quality of life ---- lung cancer prognosis
Wed, 16 May 2012 06:44:58 +0100 | MedWire News - Oncology
Self-reported quality of life at the time of lung cancer diagnosis has a significant impact on patients’ survival, show US study results. (Source: MedWire News - Oncology)

Platelet-Activating Factor and Its Basic Metabolic Enzymes in Blood of Naive HIV-Infected Patients
Wed, 16 May 2012 04:00:00 +0100 | Angiology
We examined PAF metabolism in blood of naive male patients, 8 with early HIV infection (group A) and 17 just before treatment initiation (group B), versus 18 healthy age-matched males (group C). Statistical analysis was performed with 1-way analysis of variance (ANOVA) criterion and Pearson r test. Higher PAF biosynthesis in patients’ leukocytes versus group C was accompanied by an increase in lipoprotein-associated phospholipase A2 (Lp-PLA2) activity that degrades PAF. Moreover, PAF synthesis was higher and Lp-PLA2 activity was lower in group B compared to group A. Lipoprotein-associated phospholipase A2 was positively correlated with viral load and negatively correlated with CD4 cell counts in group B. The activities of PAF-basic biosynthetic enzymes in patients’ leukocytes w...

Domestic violence among women living with HIV/---- in Kano, Northern Nigeria. - Iliyasu Z, Abubakar IS, Babashani M, Galadanci HS.
Tue, 15 May 2012 23:50:53 +0100 | SafetyLit: All (Unduplicated)
Despite the increased risk of domestic violence among women living with HIV/----, its burden has not been adequately explored in many developing countries including Nigeria. Using interviewer administered questionnaires we assessed the prevalence and risk ... (Source: SafetyLit: All (Unduplicated))

What's shame got to do with it: forced sex among married or steady partners in Uganda. - Cash K.
Tue, 15 May 2012 23:50:53 +0100 | SafetyLit: All (Unduplicated)
Research objectives were to understand the relationship between sexual, domestic and civil violence and the transmission of HIV/---- in Uganda. The focus of this paper is on forced marital sex within the context of Ugandan marital and steady partner relati... (Source: SafetyLit: All (Unduplicated))

Quality of life ---- lung cancer prognosis
Tue, 15 May 2012 23:11:11 +0100 | MedWire News - Respiratory
Self-reported quality of life at the time of lung cancer diagnosis has a significant impact on patients’ survival, show US study results. (Source: MedWire News - Respiratory)

U.S. Assistance to Africa Cut -----Related Deaths: Study
Tue, 15 May 2012 21:00:00 +0100 | The Doctors Lounge - Health News
Evaluation attributes more than 740,000 lives saved to the program launched in 2003 (Source: The Doctors Lounge - Health News)


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