Aga Kozak: What is the situation at the Infectious Hospital in Wolska?
Aneta Cybula, MD, PhD *: During these two years, COVID looked like at the beginning of the AIDS / HIV epidemic in Poland in the 90s. This is because our department – X Clinic of Infectious Diseases in Wolska – was one of the few that accepted HIV-infected people from all over Poland. All the hospitals turned into “covid” and severe AIDS cases, without COVID, they came to us. Doctors during the internships were surprised, “How is it? There are still so many cases of AIDS?”.
And is it?
Yes! And we were wondering – why the gentleman who lost 10 kg without dieting in a month – was not recognized as infected? Because he was on teleporadach… Doctors stopped seeing the patient – and that’s really not normal.
This is one of the reasons why we had late diagnoses and, unfortunately, a much higher percentage of deaths from AIDS patients compared to what we had before COVID
The patients came in a very serious condition – with advanced AIDS, and often nothing could be done. It was not a permanent situation, because it changed with the intensification of the epidemic, lockdowns, access to doctors. But we still have people in the ward with tuberculosis, cachexia, Kaposi’s sarcoma, suspected lymphoma, etc.
And it would seem that maybe HIV will subside, because with the lockdown, chemsex parties, one of the main sources of infection, have ended.
At the beginning of the pandemic, many people stopped taking PreP – which protects against infection – because “there was nowhere to get infected”.
However, as soon as the first fear passed – the parties returned and I know from the patients that it was like on the Titanic – let’s have fun while we live! So there were more parties than usual. Group sex or gangbangs have moved from clubs to private homes
My observations show that while perhaps the statistics have not changed – because in Poland about 1000 people a year are infected – then suddenly many infected 30-year-olds appeared.
For us, doctors, it was a shock, because we usually have elderly patients, and then suddenly a flood of young people with AIDS. People who have never examined themselves in their entire sex life – which is probably a sign of the times: we are no longer afraid, the young generation is not traumatized by the first epidemic, and the slogan “Philadelphia” is associated with cheese for sandwiches rather than a film with Tom Hanks
As I understand it, it happened that these patients came to the tests because they had a cough, fever and suspected COVID …
… but it turned out to be pneumocystosis pneumonia, or AIDS indicator disease.
Do you especially remember any case that you can tell about?
Just thinking that he has COVID, a young Ukrainian boy, who started living in Poland with his girlfriend, came to us. Heteronormative, not MSM …
So “a man having sex with men”.
… who has never been tested in his life. It turned out that his first girlfriend had it infected about 10 years ago. He had a profound immune deficit – AIDS. It was amazing because his girlfriend loved him so much that she kept asking if she would be able to have healthy children with him. Even before taking your result – the result that it’s infected! And you know that before being transported by ambulance to Ukraine, he proposed to her and they left as fiancés? We have a few such stories …
Is “AIDS” like that boy was curable?
AIDS is a group of diseases, some of them incurable. If someone does not have brain lymphoma or so-called PML, we are able to get him out of this state. Of course, with low immunity, various complications can appear – e.g. sepsis – but
AIDS is no longer synonymous with a death sentence.
This is a sign that a person has reached a point where he has a very low immunity and usually an indicator disease: pneumocystosis pneumonia, tuberculosis, Kaposi’s sarcomas, cryptococcosis, etc.
How is HIV / AIDS broken down by gender?
At the age of 18-30, we have six thousand treated men in Poland and seven times fewer women. In Poland, we have the advantage of MSM – that is men who have sex with men or males who have sex with males, men who have sexual contact with men. There are countries in Europe where more women are infected, such as Estonia, Portugal, and more heterosexual couples are infected, through injecting drug use.
Meanwhile, in Poland people who use, for example, injecting drugs are already a marginal group in our statistics, although of course it still happens that some people inject themselves with the same needle.
In Poland, at the time, education was directed mainly to LGBT groups and people who use drugs, right?
It was so. It is getting worse with education now. While the MSM group is actually aware of, for example, how PrEP or PEP works, the latest campaign of the National AIDS Bureau is very simple, it communicates that HIV is transmitted from person to person.
It would seem that this is basic information that does not need to be repeated anymore. That not through the towel, pool, lake, use of the same toilet …
Yet, based on surveys of people between the ages of 18 and 30, we know that the vast majority do not know about such things. It is not quite possible to “dazzle” with words and images about the condom – the basic barrier against HIV transmission and most sexually transmitted diseases – because there is no point in counting on the support of such a vision by the Ministry of Health.
It is interesting what these surveys also showed that after risky sexual contact, women come for testing much earlier than men. Women after 3-4 weeks, men after 3-12 months!
What you often mention in the context of HIV / AIDS is a kind of anesthesia.
Yes, because the fact that the patient is losing 10 kg and the doctor does not see it, “because teleportation” is one thing, but the fact that this person has a father, mother, sometimes colleagues and no one will take care of it – I do not understand. We had a patient who went to work in a bank and weighed 47 kilos. Nobody will persuade me that my colleagues did not see that it was very bad with him. After returning home from the hospital, he likely committed suicide – despite being treated.
I call it ‘psychic GDPR’, meaning ‘I will not interfere with anyone’s life’. And it really makes people die.
We also had a patient who worked as a cleaner in a hospital. How did he and none of the doctors examine him, since he looked like a textbook and devastating AIDS?
Have you seen your patients during these two years?
In the first months of the pandemic, we spoke mainly on the phone. The issue of collecting medications was organized in such a way that patients could receive them in envelopes – they did not enter the hospital premises. The patients were very disciplined, and almost no one discontinued treatment. It is amazing how effective the current antiretroviral treatment is – during the most difficult time of the pandemic, the patient may have been without tests for a year, as he was previously stable and had undetectable HIV viral load – it was all ok! But I admit there was a longing on both sides. How many times have I heard “Doctor, I’m finally seeing you!” spoken with joy at the first meeting face to face! In the end, it was possible to talk – because we lead some patients, for example, for 20 years – so we know each other like bald horses.
Before COVID, 9 percent were tested. society.
And during the last two years, certainly less, because the consultation points were closed. So you couldn’t test yourself for free.
In general, we do less research, and we should, because we’re talking about HIV here, and meanwhile, other STDs are doing very well – especially syphilis.
People think “I’m on PrEP, I won’t get HIV,” but syphilis, yes! It is also spread during oral sex and is not only applicable to MSM, for example.
Okay, what should we get tested for? Syphilis…
HCV – hepatitis C, which is transmitted through anal sexual contact. As I talk to many young people, I can understand my aversion to oral sex in a condom, but in the case of anal intercourse, the condom will protect us from transmitting most diseases !!! I understand that you think, “Eh, this will heal quickly, like gonorrhea or syphilis.” Yes and no – treatment is one thing, but then there are check-ups to make sure we are cured …
Sexually active women should be vaccinated against the papillomavirus so that they do not develop cervical cancer. Dot. Men can get genital warts too – so they should get vaccinated as well. Let’s look for programs that will help us vaccinate ourselves with Gardasil 9 – it covers nine types of HPV, so even after an illness or infection, we protect ourselves against others. This vaccine has also been shown to reduce recurrence of lesions.
Unfortunately, it costs from PLN 429.90 to PLN 879.00 for one dose, and you need …
… three doses after the age of 15 – but then it really protects us for life.
How often should we test ourselves?
Once every three months – unless we have a permanent partner, so we just do it before entering into a new relationship. Although I’ve seen so much, I can’t imagine being able to live with someone and just believe that someone “has nothing”. The cited story of a boy from Ukraine also taught me that – he really did not know.
And by the way, people now have a loose approach to HIV, because they know it’s curable, and that drugs are free. Once my patients asked me ‘How long will I live?’, Now they want to know ‘What will the side effects be?’, ‘Are there any new drugs?’
And are they?
In the United States and elsewhere, antiretroviral drugs are given as an injection into a muscle that is taken once every two months. They will also appear in Poland at any moment. For some, it is a great convenience and a different way of thinking about treatment – “I don’t have to think about infection with every pill.” Sometimes I am afraid of what it will be, if it will be so light, no problems – will people, for example, forget to say that they are infected to their dentist? Will they be more carefree?
What would you like on December 1?
Make HIV testing routine. If we diagnose people who do not know they are infected, they can be treated quickly. This is the easiest way in the world to reduce the AIDS epidemic.
And that the great slogan of a really great campaign appears in our mentality: “EVERY TEST RESULT IS GOOD. Take care of yourself and others”.
I hope these are not too many wishes for a goldfish …
Aneta Cybula, MD, PhD photo. private archives
* Aneta Cybula, MD, PhD works at the Department of Infectious and Tropical Diseases and Hepatology at the University of Warsaw. Academic teacher, popularizes knowledge about HIV / AIDS. Laureate of the LGBT + Diamond Awards.