Assoc. Dr. Ivan B altadjiev, MD, acquired a master's degree in medicine at the Medical University of Plovdiv, specializing in infectious diseases. He is currently practicing at the Department for Patients with Acquired Immune Deficiency at the Infectious Diseases Clinic of St. George Medical Center, Plovdiv. Prof. B altadzhiev holds the position of chief assistant at the Medical University of Plovdiv.
Approximately 300 patients with HIV/AIDS are monitored on an outpatient basis in the sector, with an average of 30-40 new cases of all ages being registered annually. Inpatient treatment is also provided in a separate building of the Infectious Diseases Clinic for those who require a hospital stay. The sector for patients with acquired immunodeficiency in "St. George" UMBAL is one of a total of five centers in the country and covers the treatment of patients in Central and South-Eastern Bulgaria. The other sectors are also in state university hospitals - in Sofia, Varna, Pleven and Stara Zagora. We talk to Dr. Ivan B altajiev about the modern treatment of HIV/AIDS and its benefits.
Assoc. B altadjiev on December 1 we celebrated the World Day against HIV. What are the program highlights this year?
- Emphasis is mostly on protecting the population through an information campaign, whose emphasis is on how to practice safe sex, use individual needles by people who use intravenous drugs and above all, overcome of the stigma attached to this disease, which, unfortunately, still exists.
The first thing people need to know is that you cannot get HIV by shaking hands, kissing and sharing utensils. Contact with such patients should not be avoided, as we cannot get infected from them. Contagion occurs only through blood and sexual contact. The big problem is the lack of understanding of how the disease is transmitted - there is no risk of infection in ordinary contact with HIV patients. These patients are not lepers and should not be rejected by society, because they are like all of us - like me, like you, like your readers.
According to the latest statistics, what is the prevalence of HIV in Bulgaria?
- The happy thing is that, compared to the general population, Bulgaria remains one of the countries least affected by this disease. In 2020, around 37 million people worldwide were living with HIV, with around 680,000 people dying from the disease in the same year. Overall, WHO rates HIV as one of the biggest pandemics and he alth crises in the world.
In Bulgaria, the first registered cases of HIV were in 1987, and by the end of last year their number was around 3,500. And in 2020, 183 new cases of the disease were discovered in our country, 92% of them were sexually transmitted.
The incidence is highest in Sub-Saharan and Southeast Africa.
Information has come out that due to the covid pandemic, HIV testing offices are not working and there is a shortage of tests. Are you familiar with such a problem?
- The very tests that determine the presence of HIV are done in Sofia. We take blood from the patient and send it there for analysis. I personally have not heard of a lack of tests, and our office in Plovdiv works without any problems, both in terms of doctors and nurses. We send the blood to the capital because these are highly specialized tests and we haven't had any problem so far.
What do you think about the studies that some of the antiretroviral therapy drugs are also used in coronavirus patients?
- There are similar studies. For example, one of the medications that was the subject of the study was lopinavir, or more commonly known as kaletra. At the very beginning of the covid pandemic, there were studies that they could be used in such patients, but at the moment this has not been confirmed.
Assoc. Dr. Ivan B altadzhiev
Could you tell us about the modern therapy you apply to your patients and what are your observations about its efficacy?
- The therapy, as you mentioned, is called antiretroviral. It is specifically aimed at the virus. In 1987, the first preparation, known as azidothymidine or retrovir, was released on the market, and it still exists today. After that, there were several more such medications, which are no longer available these days. And although at the beginning, in the 80s, very high hopes were placed on these medications, they were burned rather quickly, due to high mortality and ineffectiveness.
Then, around the middle of the 1990s, a number of other preparations appeared that had a much greater effect, and this was due to combining them. That is, in the beginning monotherapy (treatment with only one drug) was applied with the drug azidothymidine, until then it was switched to a combination therapy of two or three drugs, and the results were very encouraging.
When I started working with HIV, 15 years ago, patients were taking a handful of drugs - a total of about 8 tablets a day. These medications, unfortunately, also had a lot of side effects: nausea, vomiting, severe damage to the liver and bones - osteoporosis. In recent years, however, what I boldly want to say and consider most important is that there has been a revolution in this therapy, thanks to new medications – patients now only take one tablet. This also minimized the more serious side effects of the therapy – vomiting, diarrhea, rashes, liver and bone toxicity.
With the new drugs, we also achieve higher efficiency. Patients who take this antiretroviral therapy regularly have an almost undetectable viral load, or simply put, they are not contagious. The most important thing for me, and perhaps for all people, is that almost all HIV-positive women in the last 4-5 years gave birth to completely he althy children. They took antiretroviral therapy regularly - ie. non-stop, have undetectable viral loads and are non-infectious.
Are the costs of antiretroviral therapy treatment covered?
- The treatment of HIV-positive patients is taken over by the Ministry of He alth, not by the He alth Insurance Fund, and the patients' he alth insurance status does not matter here. A person, even if he is uninsured, unemployed, receives the same antiretroviral therapy that is prescribed to the insured patient.
It is important to say that the therapy is lifelong and the patient does not pay anything for it. In addition, it provides life expectancy to patients, just like to all other people. If a patient takes his HIV medication regularly, his life expectancy will not be affected in any way by the virus. And most importantly, he will have the same quality of life as people without this disease.
At the moment, treatment with antiretroviral therapy is for life. Research is being done on new drugs that can lead to the complete eradication of the virus, but they are still in the early stages and it will be some time before they pass all the necessary tests for effectiveness and safety.
Are the costs of outpatient and inpatient follow-up treatment also covered by the Ministry of He alth?
- Yes, they are also covered by the Ministry of He alth. HIV patients come to us every six months for specific tests tracking the level of viral load in the body. All this is completely free - the diagnosis, treatment and examination.
Despite great progress in the treatment of HIV, what challenges still face society in fighting this disease?
- The first thing we do every year and continue to do is the education campaign. It seeks to inform the public about how to protect themselves from infection. The goal is to emphasize prevention, because this is the most effective way to deal with the disease - that is, by preventing infection with the virus. Especially for the challenges facing society, this is exactly what people around the world have been trying to explain since the 1980s., namely – these people should not be kicked away.
In the very beginning, when the first cases of the HIV virus were found in homosexual men, there was a specific understanding in America that it was only a disease of homosexuals and no one else. In Bulgaria, there are still such misconceptions that it is a disease of homosexuals, drug addicts and people with more free sexual behavior. And many people think that this cannot happen to them, which is not true at all. No one is immune to this disease.
Another important thing to say is that for these patients complete anonymity is guaranteed.