Most HIV sufferers get treated 'reasonably early'

The majority of HIV-infected people in Malta seek treatment reasonably early, infectious diseases consultant Charles Mallia Azzopardi told The Times.

This contrasts with the situation in the United Kingdom and Ireland, where a recent study found that many sufferers were not getting treatment early enough.

When contacted to find out about the local situation, Dr Mallia Azzopardi said there were between six and 10 new cases a year and roughly 60 to 70 per cent of them present themselves for treatment reasonably early.

"Seeking treatment early is very important because they avoid many problems," he said. Dr Mallia Azzopardi said that when an infected person did not get treatment he was a "sitting duck" for related infections, which could be fatal.

Moreover, people who sought treatment late tended to respond less to the treatment.

The importance of early diagnosis is highlighted in a study published in the renowned British Medical Journal. The study found that many patients in the United Kingdom and Ireland are not having their HIV infection diagnosed until they are at a late stage of disease. It says that more than half the people with HIV in the UK who were starting treatment in 2001 had a low CD4 immune cell count, which made them susceptible to infection.

The study showed that a third of patients had presented late for treatment and less than half the patients - 41 per cent - were diagnosed via routine screening.

Moreover, the BMJ study found that in the year before diagnosis, 17 per cent of the patients had a clinical episode which was likely to be HIV-related but remained undiagnosed. These included 58 hospital admissions, 18 of which for tuberculosis. The study said data showed that 35 subsequent hospital admissions could have been avoided.

"We found a significant number of missed opportunities for early diagnosis of HIV infection with a high proportion of patients (17 per cent) who sought medical care with symptoms in the preceding 12 months but remained undiagnosed," the authors said.

There are "well recognised advantages" of early diagnosis of HIV, including public health and health cost benefits, together with personal benefit to the patient who can start the appropriate treatment at an early stage.

When contacted, Philip Carabot, the doctor in charge of the Genitourinary (GU) Clinic at Boffa Hospital, stressed the importance of HIV testing being part and parcel of GU tests. He said HIV was another of a number of STIs which patients at risk needed to be tested for.

One of the problems with HIV, as with a number of other sexually transmitted infections (STIs), is that it is silent. In fact, when asked what the first symptoms of HIV infection were, Dr Carabot said that sometimes these were so trivial that they could be easily overlooked.

"It is important for people at risk, like those who have changed a partner, to have a full-scale test, including one for HIV," he said. Dr Carabot said it was a problem that many people were no longer afraid of HIV because they mistook the big progress made in treatment for a cure. However, there is still not a cure for HIV, which leads to Aids, and in many cases it can be fatal.

"Many people are going back to the same risky behaviour of two decades ago," he said, speaking about the situation in western countries. He explained that there was a change of behaviour in the mid-1980s when many people adopted new lifestyles because of fear of infection.

Dr Carabot lauded the increase in education about the issue, especially in schools, but added that this was not consistent across the board. However, he said, there was still a big improvement. Awareness is also increasing, with the number of people going to the GU clinic increasing annually. Last year more than 1,500 people went to the GU clinic and the majority of them were tested for HIV.

Dr Carabot stressed that statistics emanating from the clinic do not indicate the national picture, since there are people who go to their doctor or other specialist to have a test. He stressed that a doctor was obliged to keep the person's identity confidential, even though he was also obliged to give notice of any positive results, also anonymously.

He also pointed out that since there was a national code system for positive results, the annual statistics could include more than one test taken by the same person through different medical professionals.

"Since Malta is a small country, it is very difficult to find a code system which is not easily broken," he said. Only one-quarter of patients who go to the GU Clinic have been referred by a health professional, he said.

The other 75 per cent go to the clinic to get checked for sexually transmitted infections of their own accord.

"All those who come here are offered an HIV test, and the vast majority accept," he said.