Despite advances in treatment which have transformed HIV into a chronic disease rather than a fatal one, Dr Mary Horgan, a consultant in infectious diseases at Cork University Hospital, warns against complacency. "We are seeing increasing numbers of HIV cases which have been transmitted by heterosexual means. These could be prevented," she says.
About 150 new cases of HIV infection are diagnosed in the Republic every year. Since regular testing became available in the 1980s, 2,195 people in this State have tested positive for the virus.
Last year saw a significant rise in the incidence of HIV: 209 new cases were diagnosed. This rise mirrors the increase in other sexually-transmitted diseases. It is a worrying trend, suggesting the "safe sex" message is being lost in the roar of the Celtic Tiger.
The percentage of heterosexually-transmitted cases of HIV has increased from 13 per cent in 1993 to 29 per cent in 1998. So while HIV/AIDS continues to be predominantly a disease of homosexuals and intravenous drug-users, heterosexual cases are on the rise.
The Republic is involved in research into drug treatments, with Dr Fiona Mulcahy and her team at St James's Hospital Dublin defining the optimal treatment regimens for HIV-infected injecting drug-users.
"HIV care is as good here as it is in the United States," says Dr Horgan. She and other specialists have access to the latest drug treatments and diagnostic facilities.
Treatment involves first measuring the level of disease activity, finding the "viral load" which is the number of HIV viruses in the body. A test called a CD4 count is also used as a measurement of disease activity and also to see how well a treatment works. Treatment is highly individualised, but usually involves one of three different types of inhibitor drug. Factors such as how easy a particular regimen is to take are discussed fully with the patient.
Early in the disease, it is usually possible to use a simplified regimen with fewer side-effects. Later in the disease it may be necessary to introduce more complex treatments.
The key is to get the patient to understand the process and to fully accept the particular treatment. Otherwise, non-compliance with drugs will be high and the disease will progress unchallenged, ultimately requiring more complex and possibly more unpleasant treatments.
The aim of HIV treatment is to prevent the breakdown of the immune system and thus prevent progression to full-blown AIDS. It is the success of modern treatments which have transformed HIV infection into a chronic disease. Cure remains elusive, but control is achieved using triple therapy.
Some 691 people were diagnosed with AIDS in the State up to December 1999. Of these, 349 have died, representing a 50.5 per cent mortality rate. However, the 17 deaths in 1999 reflect a downward trend and indicate the success of treatments.
However, a note of caution from last year's HIV figures. The additional 50 or so cases might represent the beginning of an unwelcome trend. When taken with the increase in the percentage of heterosexually-transmitted HIV, the need for effective prevention programmes clearly remains.
Today Poz Ireland publishes its fourth edition of HIV Treatments 2001. Poz Ireland is a non-profit charity and helps to provide information to those affected by the virus. It is available, free, by writing to GPI Publications, PO Box 5187, Dublin 6, with your name and address. Alternatively, it can be ordered by e-mail at gpi@poz.iol.ie