Selected Podcast
Undetectable = Untransmittable: Getting to Zero HIV Infections
This podcast explores efforts to advance HIV testing, treatment, and prevention. Dr. Déry discusses the role of testing, Pre-Exposure Prophylaxis (PrEP), and Non-Occupational Post-Exposure Prophylaxis (nPEP), among other things, to achieve undetectable HIV viral loads to make it untransmittable (U=U).
Featuring:
MarkAlain Déry, DO, MPH, FACOI
MarkAlain Déry, DO, MPH, FACOI, is an Assistant Professor of Clinical Medicine at Tulane University, where he also serves as Director of the Tulane AIDS Education and Training Center, Director of the Tulane T-Cell Clinic, and Medical Director of the Antimicrobial Stewardship Program. He earned his master’s degree in public health at Loma Linda University and graduated with his degree in osteopathic medicine from the University of New England before completing his internal medicine training at Case Western Reserve University. After three and a half years on the Navajo Reservation as part of the Public Health Service, he relocated to New Orleans and completed an infectious disease fellowship at Tulane University. As an infectious disease expert with a keen interest in antimicrobial resistance, infection control, and multidrug-resistant organisms, Dr. Déry works to combat poverty’s negative health effects. He is passionate about HIV prevention and testing. Dr. MarkAlain Dery specializes in the diagnosis and treatment of HIV/AIDS. He is the founder of 102.3 WHIV FM, a radio station dedicated to human rights and social justice. Transcription:
ACScott Webb: Hello and welcome to the American College of Osteopathic Internists podcast, Docs Off The Clock. Juggling the business of medicine and caring for patients means doctors always seem to be on the clock. Docks Off The Clock features some of today's best voices in healthcare with tips on how to live a better balanced life.
Thank you for stopping by today. The purpose of today's podcast is to discuss U equals U and how it could lead to zero HIV infections around the world. And joining me today is Dr. MarkAlain Déry. He specializes in the diagnosis and treatment of HIV and AIDS, hepatitis C and much more with Access Health Louisiana. I'm Scott Webb. And doctor, as we get rolling here, please explain what U equals U means to listeners.
Dr. MarkAlain Dery: Absolutely. And it's such a important tool that we've been using to help not only people living with HIV to understand the disease process, but also we've been using it as an incredibly effective anti-stigma tool as well. So U equals U stands for undetectable equals untransmissable. And essentially what that means, and we're at a point now and we understand the science that if somebody's HIV viral load that we're able to measure, just with standard blood tests that you get when you go to your doctor's office, right? So we measure the viral load. If somebody's HIV viral load is undetectable, that means that they are at a point where they can have unprotected intercourse with their intimate partners and not transmit HIV to somebody else. That's a very important point.
And it's an important tool to help decrease the stigma associated with HIV and to know that you're very well-protected, sort of the same way that we know that if you wear a mask, that you're not going to transmit COVID, right? So that's kind of the same way, the understanding that if you're undetectable, you're not going to transmit HIV to your intimate partner. If you're undetectable, that means that you could go ahead and have a child, both either if you're male or female and know that if you're male, you're not going to transmit HIV to your potential unborn child and, if you're female, you know that if you're undetectable, you're not going to transmit HIV in utero. So it's an incredibly important tool. And it's one, like I said, that has empowered people living with HIV because they now can have non-stigmatized sexual lives that have been removed from them over the course of the past 40 years as people stigmatized the sexual health component of living with HIV.
Scott Webb: Yeah, it's so interesting and what a great analogy. We've all unfortunately learned about the importance of masking and how key that is to not spreading things. So that untransmissable part is so huge. And when we think about increasing things like testing, diagnosis, treating and maintaining lifelong care regarding HIV, we know that that's how we'll get to an HIV-free world. And I guess I want to ask you, do you believe that we can get there? Can we live in an HIV-free world?
Dr. MarkAlain Dery: Yeah. it is completely possible to live in an HIV-free world. And just something to kind of consider as well is that in the US we have lost somewhere upwards to 750,000 to 760,000, maybe a little bit more, to COVID in about two years. The number of people who've died of AIDS and HIV-related conditions over the past 40 years is 700,000. So just with COVID alone, we've exceeded the number of people who've died of HIV.
So while it will be impossible for us to get to a COVID-free world because the COVID will be with us because it circulates in other mammals and it has other reservoirs. With HIV, we can stop the virus from circulating without a vaccine. And that's largely due to the fact that if we test everybody, and I mean the entire globe, and get everybody started on HIV medications, then we will drive their viral loads to undetectable status. Again, once they get to undetectable, they don't transmit HIV to anybody else. So we can stop HIV infection with the person actually having HIV with making sure that they take their medications regularly so they do not transmit HIV to anybody else.
So it is potentially possible for us to be able to actually eliminate HIV altogether without a vaccine, just by making sure that the entire globe gets tested and treated for HIV, ensuring that the infection stops with that particular host. And so that's how we would get to an HIV-free world and I do believe it's possible.
Scott Webb: Yeah. And it's good to hear that both you're encouraged and have a really clear sense of what that path is. And, you know, doc, I've seen these commercials and I think I understand, but I want to have you explain to listeners what exactly is PrEP and who should be taking it?
Dr. MarkAlain Dery: So PrEP is this incredible tool that we have at our disposal. It stands for pre-exposure prophylaxis. And essentially, what that does is for people who do not have HIV, so they're HIV-negative, but they are at risk for acquiring HIV. So who would that be? Those are usually men who have sex with men are at higher risk for HIV, commercial sex workers are at higher risk for HIV. So individuals that are at higher risk for HIV can take a pill once a day, and that will prevent HIV transmission.
And so PrEP is a tool that we utilize for people who are HIV negative so as to prevent HIV transmission. So if they did have an exposure, if they had an intimate encounter in which exposure and transmission occurs, if somebody takes PrEP regularly, it can reduce the risk of transmission by almost a hundred percent. So it's 99% effective when taken daily.
Scott Webb: That's amazing. And we mentioned earlier that it's been 40 years and you think about how far we've come. I know we're recording this around the time of World AIDS Day and the theme this year really hit home for me, End Inequalities, End AIDS, End Pandemics, which I'm sure sounds good to all of us, HIV, you know, COVID and so on. I'm wondering though, can you speak about the inequalities? What does that mean exactly when it comes to AIDS?
Dr. MarkAlain Dery: Yeah. Absolutely. One thing that we have to take in consideration, and this has been something I've been talking about for, you know, a quarter of a century, 25 years since I've been doing this, is talking about the inequalities that exist within infectious diseases. And one thing that has made my life a little bit easier in a silver lining, if you will, is COVID has helped a lot of people see a lot of things the way that I've been trying to talk about it. Because just like COVID unearthed a lot of inequities, it was very clear to see that COVID initially and to this day disproportionately affects communities of color, disproportionately affects those people who are at the lower levels of the socioeconomic scale.
Same thing with HIV. And then when you take a really big step backwards, really infectious diseases tend to be diseases of the poor. And what we're really talking about here are inequities that are structural to our overall systems of government really. And we see that structural discrimination that exists. And, unfortunately as a by-product of that structural discrimination that exists within our society, people who are at that pointy end of that spear, they're the ones that are at greater risk for infections. And so when you look at those individuals who are at highest risk for COVID, for a highest risk of COVID mortality or severity of disease, those are the same individuals that are at highest risk for HIV transmission and HIV infection as well. So really these tend to be societal issues. And until we address those societal issues, until we address the poverty basically, we can turn around poverty immediately if we as a society chose to do so. And unfortunately, that is not something that we do. And so these are the uncomfortable truth that exists, but this is what infectious disease is. These are the things that need to be talked about. And so I appreciate that on this World AIDS Day, embedded into the theme is really not only ending pandemics and ending HIV, but really ending inequities that exist within our system and particularly within our healthcare system.
Scott Webb: That's well said. I want to have you talk about Noise Filter. I had the opportunity, the pleasure really, of checking out some of your work as a fellow podcaster. So the podcasts and live shows and the animated videos are amazing. I wanted to have you brag a little bit and explain to folks, you know, who's the target audience for Noise Filter and the whole plethora of things that you do and really what's the mission?
Dr. MarkAlain Dery: Right. Thank you. And I appreciate the opportunity. Folks can find more information at noisefiltershow.com. That's noisefiltershow.com. My colleague and I, Doc Griggs is a person that I've been doing radio with for many, many years on Tuesday mornings here in New Orleans. And we were on a regular radio station here. And we would just, once a week, just go into the studio and broadcast and just talk about issues of the day, the medical issues of the day.
When COVID happened, of course, that was impossible. The radio stations and everything kind of more or less shut down. And Eric and I, Doc Griggs and I, kind of shifted our efforts into podcasting and we started a 10-minute daily podcasts looking at COVID through the eyes of social, economic, environmental and racial justice. So it wasn't just two doctors talking about COVID, but it was contextualizing it within the notion of justice.
And from that perspective, it got picked up by Pacifica Network. So we have something like 80,000 listeners a day plus several thousand subscribers as well. And then about six months into our podcasting ventures and new careers as podcasters, it occurred to us as the vaccine was being released, the mRNA COVID vaccine, that people had a hard time understanding who were not scientists how the vaccine actually worked. And so, Doc G riggs and I were like, "Well, let's just animate ourselves and let's just show how the vaccine works from an animated perspective." And we did two on the mRNA vaccines. So we were really ahead of the curve with that, with the variants and the boosters.
And then, as a result of those two, we got some more money. They said, "Well, can you do this with HIV?" So we did three of them on HIV. One was on U equals U, one was on PrEP, of course, which we just talked about. And then the third one was nPEP. So whereas PrEP prevents exposure from happening, nPEP is if you had an exposure, let's say you had an exposure last night or there was a condom failure last night, and there was concern of HIV exposure, well, we can put you on HIV medicines for 30 days, and that will prevent transmission as well. And that's called nPEP. So we did those three videos.
And then again, all of a sudden we got more, you know, calls. "Hey, can you animate hepatitis C and how if we just test, treat and cure hepatitis C?" Sure enough, we went ahead into that and then we got another call to do something for clinical trials and how to increased ethnic diversity in clinical trials. And we're doing that one with Tulane University.
So we've now found ourselves in this interesting world of just kind of taking complex medical concepts and really trying to explain them as simply as possible. And that's what we do with Noise Filter. And we've been really successful in doing that with the animations. And again, you can find those animations at noisefiltershow.com and then there's a tab that says watch. And we're super proud of those animations and we put a lot of work into them. And so they're out there in the world for people to enjoy and to use as teaching tools. They're meant to be freely distributed.
Scott Webb: Well, I appreciate that because I watched all of them before we spoke today. And hopefully, you still have time to be a doctor. You have this whole secondary career now, sort of an entertainer, if you will, an entertaining doctor and they certainly were, but also very educational as was this conversation. So doctor, I really do appreciate your time, your compassion, your expertise, and you stay well.
Dr. MarkAlain Dery: Thank you so much. I really appreciate it.
Scott Webb: And thank you for spending a little time with us today. We look forward to future podcasts where we'll continue to explore issues of importance to you. For additional information, please contact the ACOI directly at 1-800-327-5183 or by visiting our website at acoi.org. You can also email us at acoi@acoi.org. Until next time, be well.
ACScott Webb: Hello and welcome to the American College of Osteopathic Internists podcast, Docs Off The Clock. Juggling the business of medicine and caring for patients means doctors always seem to be on the clock. Docks Off The Clock features some of today's best voices in healthcare with tips on how to live a better balanced life.
Thank you for stopping by today. The purpose of today's podcast is to discuss U equals U and how it could lead to zero HIV infections around the world. And joining me today is Dr. MarkAlain Déry. He specializes in the diagnosis and treatment of HIV and AIDS, hepatitis C and much more with Access Health Louisiana. I'm Scott Webb. And doctor, as we get rolling here, please explain what U equals U means to listeners.
Dr. MarkAlain Dery: Absolutely. And it's such a important tool that we've been using to help not only people living with HIV to understand the disease process, but also we've been using it as an incredibly effective anti-stigma tool as well. So U equals U stands for undetectable equals untransmissable. And essentially what that means, and we're at a point now and we understand the science that if somebody's HIV viral load that we're able to measure, just with standard blood tests that you get when you go to your doctor's office, right? So we measure the viral load. If somebody's HIV viral load is undetectable, that means that they are at a point where they can have unprotected intercourse with their intimate partners and not transmit HIV to somebody else. That's a very important point.
And it's an important tool to help decrease the stigma associated with HIV and to know that you're very well-protected, sort of the same way that we know that if you wear a mask, that you're not going to transmit COVID, right? So that's kind of the same way, the understanding that if you're undetectable, you're not going to transmit HIV to your intimate partner. If you're undetectable, that means that you could go ahead and have a child, both either if you're male or female and know that if you're male, you're not going to transmit HIV to your potential unborn child and, if you're female, you know that if you're undetectable, you're not going to transmit HIV in utero. So it's an incredibly important tool. And it's one, like I said, that has empowered people living with HIV because they now can have non-stigmatized sexual lives that have been removed from them over the course of the past 40 years as people stigmatized the sexual health component of living with HIV.
Scott Webb: Yeah, it's so interesting and what a great analogy. We've all unfortunately learned about the importance of masking and how key that is to not spreading things. So that untransmissable part is so huge. And when we think about increasing things like testing, diagnosis, treating and maintaining lifelong care regarding HIV, we know that that's how we'll get to an HIV-free world. And I guess I want to ask you, do you believe that we can get there? Can we live in an HIV-free world?
Dr. MarkAlain Dery: Yeah. it is completely possible to live in an HIV-free world. And just something to kind of consider as well is that in the US we have lost somewhere upwards to 750,000 to 760,000, maybe a little bit more, to COVID in about two years. The number of people who've died of AIDS and HIV-related conditions over the past 40 years is 700,000. So just with COVID alone, we've exceeded the number of people who've died of HIV.
So while it will be impossible for us to get to a COVID-free world because the COVID will be with us because it circulates in other mammals and it has other reservoirs. With HIV, we can stop the virus from circulating without a vaccine. And that's largely due to the fact that if we test everybody, and I mean the entire globe, and get everybody started on HIV medications, then we will drive their viral loads to undetectable status. Again, once they get to undetectable, they don't transmit HIV to anybody else. So we can stop HIV infection with the person actually having HIV with making sure that they take their medications regularly so they do not transmit HIV to anybody else.
So it is potentially possible for us to be able to actually eliminate HIV altogether without a vaccine, just by making sure that the entire globe gets tested and treated for HIV, ensuring that the infection stops with that particular host. And so that's how we would get to an HIV-free world and I do believe it's possible.
Scott Webb: Yeah. And it's good to hear that both you're encouraged and have a really clear sense of what that path is. And, you know, doc, I've seen these commercials and I think I understand, but I want to have you explain to listeners what exactly is PrEP and who should be taking it?
Dr. MarkAlain Dery: So PrEP is this incredible tool that we have at our disposal. It stands for pre-exposure prophylaxis. And essentially, what that does is for people who do not have HIV, so they're HIV-negative, but they are at risk for acquiring HIV. So who would that be? Those are usually men who have sex with men are at higher risk for HIV, commercial sex workers are at higher risk for HIV. So individuals that are at higher risk for HIV can take a pill once a day, and that will prevent HIV transmission.
And so PrEP is a tool that we utilize for people who are HIV negative so as to prevent HIV transmission. So if they did have an exposure, if they had an intimate encounter in which exposure and transmission occurs, if somebody takes PrEP regularly, it can reduce the risk of transmission by almost a hundred percent. So it's 99% effective when taken daily.
Scott Webb: That's amazing. And we mentioned earlier that it's been 40 years and you think about how far we've come. I know we're recording this around the time of World AIDS Day and the theme this year really hit home for me, End Inequalities, End AIDS, End Pandemics, which I'm sure sounds good to all of us, HIV, you know, COVID and so on. I'm wondering though, can you speak about the inequalities? What does that mean exactly when it comes to AIDS?
Dr. MarkAlain Dery: Yeah. Absolutely. One thing that we have to take in consideration, and this has been something I've been talking about for, you know, a quarter of a century, 25 years since I've been doing this, is talking about the inequalities that exist within infectious diseases. And one thing that has made my life a little bit easier in a silver lining, if you will, is COVID has helped a lot of people see a lot of things the way that I've been trying to talk about it. Because just like COVID unearthed a lot of inequities, it was very clear to see that COVID initially and to this day disproportionately affects communities of color, disproportionately affects those people who are at the lower levels of the socioeconomic scale.
Same thing with HIV. And then when you take a really big step backwards, really infectious diseases tend to be diseases of the poor. And what we're really talking about here are inequities that are structural to our overall systems of government really. And we see that structural discrimination that exists. And, unfortunately as a by-product of that structural discrimination that exists within our society, people who are at that pointy end of that spear, they're the ones that are at greater risk for infections. And so when you look at those individuals who are at highest risk for COVID, for a highest risk of COVID mortality or severity of disease, those are the same individuals that are at highest risk for HIV transmission and HIV infection as well. So really these tend to be societal issues. And until we address those societal issues, until we address the poverty basically, we can turn around poverty immediately if we as a society chose to do so. And unfortunately, that is not something that we do. And so these are the uncomfortable truth that exists, but this is what infectious disease is. These are the things that need to be talked about. And so I appreciate that on this World AIDS Day, embedded into the theme is really not only ending pandemics and ending HIV, but really ending inequities that exist within our system and particularly within our healthcare system.
Scott Webb: That's well said. I want to have you talk about Noise Filter. I had the opportunity, the pleasure really, of checking out some of your work as a fellow podcaster. So the podcasts and live shows and the animated videos are amazing. I wanted to have you brag a little bit and explain to folks, you know, who's the target audience for Noise Filter and the whole plethora of things that you do and really what's the mission?
Dr. MarkAlain Dery: Right. Thank you. And I appreciate the opportunity. Folks can find more information at noisefiltershow.com. That's noisefiltershow.com. My colleague and I, Doc Griggs is a person that I've been doing radio with for many, many years on Tuesday mornings here in New Orleans. And we were on a regular radio station here. And we would just, once a week, just go into the studio and broadcast and just talk about issues of the day, the medical issues of the day.
When COVID happened, of course, that was impossible. The radio stations and everything kind of more or less shut down. And Eric and I, Doc Griggs and I, kind of shifted our efforts into podcasting and we started a 10-minute daily podcasts looking at COVID through the eyes of social, economic, environmental and racial justice. So it wasn't just two doctors talking about COVID, but it was contextualizing it within the notion of justice.
And from that perspective, it got picked up by Pacifica Network. So we have something like 80,000 listeners a day plus several thousand subscribers as well. And then about six months into our podcasting ventures and new careers as podcasters, it occurred to us as the vaccine was being released, the mRNA COVID vaccine, that people had a hard time understanding who were not scientists how the vaccine actually worked. And so, Doc G riggs and I were like, "Well, let's just animate ourselves and let's just show how the vaccine works from an animated perspective." And we did two on the mRNA vaccines. So we were really ahead of the curve with that, with the variants and the boosters.
And then, as a result of those two, we got some more money. They said, "Well, can you do this with HIV?" So we did three of them on HIV. One was on U equals U, one was on PrEP, of course, which we just talked about. And then the third one was nPEP. So whereas PrEP prevents exposure from happening, nPEP is if you had an exposure, let's say you had an exposure last night or there was a condom failure last night, and there was concern of HIV exposure, well, we can put you on HIV medicines for 30 days, and that will prevent transmission as well. And that's called nPEP. So we did those three videos.
And then again, all of a sudden we got more, you know, calls. "Hey, can you animate hepatitis C and how if we just test, treat and cure hepatitis C?" Sure enough, we went ahead into that and then we got another call to do something for clinical trials and how to increased ethnic diversity in clinical trials. And we're doing that one with Tulane University.
So we've now found ourselves in this interesting world of just kind of taking complex medical concepts and really trying to explain them as simply as possible. And that's what we do with Noise Filter. And we've been really successful in doing that with the animations. And again, you can find those animations at noisefiltershow.com and then there's a tab that says watch. And we're super proud of those animations and we put a lot of work into them. And so they're out there in the world for people to enjoy and to use as teaching tools. They're meant to be freely distributed.
Scott Webb: Well, I appreciate that because I watched all of them before we spoke today. And hopefully, you still have time to be a doctor. You have this whole secondary career now, sort of an entertainer, if you will, an entertaining doctor and they certainly were, but also very educational as was this conversation. So doctor, I really do appreciate your time, your compassion, your expertise, and you stay well.
Dr. MarkAlain Dery: Thank you so much. I really appreciate it.
Scott Webb: And thank you for spending a little time with us today. We look forward to future podcasts where we'll continue to explore issues of importance to you. For additional information, please contact the ACOI directly at 1-800-327-5183 or by visiting our website at acoi.org. You can also email us at acoi@acoi.org. Until next time, be well.