Selected Podcast
HIV Prevention and the PrEP Program
Mackie King, PharmD discusses HIV/AIDS prevention and the PrEP Program.
Featuring:
Mackie King, PharmD, BCPS, AAHIVP, CPP
Mackie King, PharmD, BCPS, AAHIVP, CPP, is a board-certified pharmacotherapy specialist practicing in an Internal Medicine and HIV clinic where helps manage chronic disease states such as hypertension, diabetes, chronic pain, HIV, and more. Dr. King also provides pre-exposure prophylaxis for patients who may be at risk of acquiring HIV. Transcription:
Prakash Chandran: HIV is an infection that we've all heard about, but it may not be top of mind. If you're sexually active, it's important to be properly educated on learning how it's contracted and, most importantly, how you can protect yourself. We're going to talk about it with Dr. Mackie King, a clinical pharmacy specialist at New Hanover Regional Medical Center.
This is Healthy Conversations, the podcast from New Hanover Regional Medical Center. I'm Prakash Chandran. So first of all, Dr. King, let's just start with the basics here. What exactly is HIV?
Mackie King: Sure. So HIV is a virus within the human body that attacks the cells and it attacks the cells that the body normally uses to fight infection. So by having HIV kind of fights your immune response and makes you more vulnerable to other infections and diseases later down the road. Typically HIV is spread through contact with certain body fluids from one person who has HIV to someone who doesn't.
And this most commonly occurs during unprotected sex or sex without a condom.
Prakash Chandran: Okay. And I've also heard of AIDS be referenced alongside HIV. Can you explain the difference between the two?
Mackie King: Yes. HIV is the beginning stage of this disease process where your body just has the virus, but it still is able to Mount a good immune response. So you still have a good response from the body. You're able to fight off these infections. HIV can be defined whenever we get a lab value that tells us kind of how your immune response is.
This is the number of called your CD4 count. So once your CD4 count falls below a specific number, then you might be diagnosed with AIDS. So this is a sign that your body is no longer able to Mount the immune response. It needs to fight off the normal infections. So if your CD4 number falls below 200 Or if you develop one of those infections that I talked about, so an infection that you or I would be able to fight off normally but because I have HIV because I don't have the immune system response that I need, you know, I may be more susceptible to something like a specific type of pneumonia. So either your number falls below 200, or you develop one of those, opportunistic infections is what we call them.
Prakash Chandran: I see. And, you know, I remember that there was a lot of awareness, about it in the early eighties to mid-nineties, because there was so much mortality that was happening. but since then, it feels like people aren't necessarily talking about HIV anymore. and as far as I know, there's still no cure for it. So can you maybe speak to that a little bit?
Mackie King: Sure. You're correct. There's not a cure for it. You know, we're still hard at work, researching for a cure. And I'm hopeful that one day we will have one, but today the best way to prevent HIV spreading is through prevention and having an undetectable viral load, which I'm sure we'll talk about later, but today there is no cure.
Researchers are hard at work for it. You know, some people think HIV has just gone away, but it hasn’t, without a doubt, the medication that we have today is so much better than it was in the past. It's much more tolerable and it's much more effective. So essentially if you get diagnosed with HIV, now you get on one of these medications.
You can basically live a long, healthy, normal life after that. And then we become more concerned about heart disease and diabetes and things like that rather than the HIV itself. It's important to know, like I said, it hasn't gone away, you know, just in, North Carolina, for example, we had about 12,000 new cases of HIV diagnosed since 2018.
So it's not going away.
Prakash Chandran: Yeah, absolutely. And so, you know, one of the things that we wanted to talk about today, because there is no cure and it is not going away. And we see these cases rising in certain regions is prevention. So when we talk about preventing the contraction of HIV, what exactly does that mean.
Mackie King: There's two main ways to prevent, contracting HIV. one of them of course, is to use a condom. So it's primarily spread through body fluid. Like we talked about, having safe, protected sex is the number one way to prevent HIV. There is new research as well. That says, if person who is diagnosed with HIV has an undetectable viral load.
So what that means is that when we look at their lab values to see how much virus is in their blood, it essentially says that there is none. So it's undetectable. Then that person can no longer transmit HIV to another person. And that is a campaign called U equals U, which means undetectable equals untransmittable. So if you have HIV, it's very well controlled, you cannot spread it. So number one strategy is to make sure everybody has an undetectable viral load. Or the second program is the prep program that you're talking about and prep stands for pre-exposure prophylaxis. And this is a program where you can take a medication to try to prevent your body from getting HIV.
If you come into contact with someone who has HIV.
Prakash Chandran: And is there a certain time horizon, which you need to take this if you come into contact with someone with HIV?
Mackie King: Yeah, so those are two different things. So the pre-exposure prophylaxis is kind of planning ahead. So you can either take this every single day, which is really what I recommend, or there's another strategy where if you know you're going to be having encounters, you can kind of take it based off of that. the other question you have is something that we called pep, which is post-exposure prophylaxis, which means, you know, I may not have anticipated coming into contact with somebody who had HIV.
So now I have to take medications to try to prevent that. So two slightly different things that we're talking about there.
Prakash Chandran: Okay. Got it. Thanks for that clarification. So when we're referring to PrEP, who are the best candidates to take it?
Mackie King: So the best candidates are you're a gay or bisexual man, and you have an HIV positive partner who does not have undetectable viral load or if you have multiple partners or if your partner has multiple partners. So they may be a good candidate, particularly if you’re not using condoms for PrEP.
If you’re heterosexual and you have an HIV positive partner, or again, you have multiple partners or your partner has multiple partners and they don't use condoms, you might also be a candidate for prep. And then the last category is if you are someone who injects drugs, if you're an IV drug user, then that's another way that HIV can be transmitted.
So it can be equally effective. If you continue to take prep to try to get HIV. So once we have the right people identified, it's really as simple as finding a provider who willing to prescribe prep. It is my belief that many primary care providers are fully capable of prescribing prep. It's pretty easy to do. You just have a little bit of lab monitoring and stuff. You have to keep up with my clinic. For example, we prescribe prep to anybody who is interested and looking for it. You can also Google prep providers, and you can look for someone in your area.
Prakash Chandran: Okay. That's helpful. And when we talk about this demographic of people that are good candidates for PrEP, they also happen to be the most at risk for contracting HIV. Is that correct?
Mackie King: A hundred percent. Yeah. So when we look specifically in North Carolina, like we talked about 1200 new cases in 2018, 65% of that population was African-American and 65% of those were men who had sex with men. And we're also seeing them occur in the younger demographics. So between 20, the early twenties, maybe even late teens to 30. Our primary population is men who have sex with men and disproportionately affects the African-American community.
Prakash Chandran: Okay. Understood. So, you know, in talking about this prevention, if someone is listening to this and they do fall into one of the demographics that you mentioned, your best advice would be talk to your primary care physician, get prescribed PrEP and take it consistently like on a weekly basis. Is that correct?
Mackie King: Yeah, so the prep is one pill every single day, for you to take and, you know, some primary care providers feel very comfortable doing this and others don't. if you’re a primary care provider doesn't, then I would encourage you to find a provider by Googling a provider who does so. For example, we prescribe PrEP at NHRMC Physician Specialists. You can make an appointment with myself or someone else who are in. We can have that discussion. So once you get prescribed prep, it's one pill a day, it's called either Truvada or Descovy and you take this one tablet every single day. All you have to do from there on out is have an appointment about every three months with your provider. We have appointments so that we can make sure that you indeed have not come into exposure with HIV. So when I see a patient, I'll test them for HIV every three months, I'll just do safety monitoring. double-check and make sure their kidneys are okay. Everything seems to be looking fine. And then based on kind of their, sexual habits.
We may screen for other diseases as well, like syphilis or gonorrhea once or twice a year, because it's important to note while prep is great for HIV, it does not prevent other sexually transmitted infections like syphilis and gonorrhea. Only condoms can do that.
Prakash Chandran: So I was just curious as to why other providers are hesitant to prescribe it. Are there side effects that people should be aware of?
Mackie King: Well, yes, so every medication has side effects. There's no doubt to that. you know, it's my belief that looking at the two options, Truvada and Descovy, you know, Descovy was created because it has a little bit safer profile then Truvada, but again, both of them are okay. You know, if your listeners go home and Google it, they're going to read stuff about kidneys. They'll see stuff about affecting the bones. And those are very valid concerns, which is why we do that safety monitoring. So I make sure that we're checking our patient's kidneys to make sure that they're functioning just fine. And if we ever were to see any signs that they weren't, then we could stop the medication.
I think that some providers are really just unfamiliar with it. You know, it's not something that they may feel comfortable having that conversation with their patients. And because of that, it may not even get brought up. You know, sometimes it's hard to have these conversations with patients about sexual behaviors, unless you've kind of had that specific training.
Prakash Chandran: Okay. That makes sense. And one of the things I wanted to address is that there's going to be people listening to this that have already been diagnosed with HIV. What recommendations might you have for them?
Mackie King: Yeah. So at NHRMC Physician Specialists, we have an HIV primary care clinic and, you know, we're always willing to accept new patients and happy to providing care. if you are diagnosed and you do not have medications, I encourage you to find a provider as soon as possible because those medications they're so well tolerated nowadays, compared to what they used to be.
And if you get on medication early, like I said before, you can virtually live a completely normal life from there on out.
Prakash Chandran: Okay. Good to know. Just before we close here, is there anything else that you'd like to share with our audience about HIV prevention or the PrEP program?
Mackie King: the only another word that I would mention is, you know, just everybody should know their status. So if you have the opportunity to get an HIV test, if you've not been tested, if your sexual behaviors have changed, it's always a good time to get tested. So if you know your status, then you can pursue appropriate treatment.
If needed.
Prakash Chandran: Well, Dr. King, thank you so much for your time today. It's been truly informative. That's Dr. Mackie King, a clinical pharmacy specialist at New Hanover Regional Medical Center. To schedule an appointment with Dr. King call at (910) 662-9300. Or visit NHRMCphysiciangroup.org to learn more about the practice.
If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been Healthy Conversations, the podcast from New Hanover Regional Medical Center. Thanks and we'll talk next time.
Prakash Chandran: HIV is an infection that we've all heard about, but it may not be top of mind. If you're sexually active, it's important to be properly educated on learning how it's contracted and, most importantly, how you can protect yourself. We're going to talk about it with Dr. Mackie King, a clinical pharmacy specialist at New Hanover Regional Medical Center.
This is Healthy Conversations, the podcast from New Hanover Regional Medical Center. I'm Prakash Chandran. So first of all, Dr. King, let's just start with the basics here. What exactly is HIV?
Mackie King: Sure. So HIV is a virus within the human body that attacks the cells and it attacks the cells that the body normally uses to fight infection. So by having HIV kind of fights your immune response and makes you more vulnerable to other infections and diseases later down the road. Typically HIV is spread through contact with certain body fluids from one person who has HIV to someone who doesn't.
And this most commonly occurs during unprotected sex or sex without a condom.
Prakash Chandran: Okay. And I've also heard of AIDS be referenced alongside HIV. Can you explain the difference between the two?
Mackie King: Yes. HIV is the beginning stage of this disease process where your body just has the virus, but it still is able to Mount a good immune response. So you still have a good response from the body. You're able to fight off these infections. HIV can be defined whenever we get a lab value that tells us kind of how your immune response is.
This is the number of called your CD4 count. So once your CD4 count falls below a specific number, then you might be diagnosed with AIDS. So this is a sign that your body is no longer able to Mount the immune response. It needs to fight off the normal infections. So if your CD4 number falls below 200 Or if you develop one of those infections that I talked about, so an infection that you or I would be able to fight off normally but because I have HIV because I don't have the immune system response that I need, you know, I may be more susceptible to something like a specific type of pneumonia. So either your number falls below 200, or you develop one of those, opportunistic infections is what we call them.
Prakash Chandran: I see. And, you know, I remember that there was a lot of awareness, about it in the early eighties to mid-nineties, because there was so much mortality that was happening. but since then, it feels like people aren't necessarily talking about HIV anymore. and as far as I know, there's still no cure for it. So can you maybe speak to that a little bit?
Mackie King: Sure. You're correct. There's not a cure for it. You know, we're still hard at work, researching for a cure. And I'm hopeful that one day we will have one, but today the best way to prevent HIV spreading is through prevention and having an undetectable viral load, which I'm sure we'll talk about later, but today there is no cure.
Researchers are hard at work for it. You know, some people think HIV has just gone away, but it hasn’t, without a doubt, the medication that we have today is so much better than it was in the past. It's much more tolerable and it's much more effective. So essentially if you get diagnosed with HIV, now you get on one of these medications.
You can basically live a long, healthy, normal life after that. And then we become more concerned about heart disease and diabetes and things like that rather than the HIV itself. It's important to know, like I said, it hasn't gone away, you know, just in, North Carolina, for example, we had about 12,000 new cases of HIV diagnosed since 2018.
So it's not going away.
Prakash Chandran: Yeah, absolutely. And so, you know, one of the things that we wanted to talk about today, because there is no cure and it is not going away. And we see these cases rising in certain regions is prevention. So when we talk about preventing the contraction of HIV, what exactly does that mean.
Mackie King: There's two main ways to prevent, contracting HIV. one of them of course, is to use a condom. So it's primarily spread through body fluid. Like we talked about, having safe, protected sex is the number one way to prevent HIV. There is new research as well. That says, if person who is diagnosed with HIV has an undetectable viral load.
So what that means is that when we look at their lab values to see how much virus is in their blood, it essentially says that there is none. So it's undetectable. Then that person can no longer transmit HIV to another person. And that is a campaign called U equals U, which means undetectable equals untransmittable. So if you have HIV, it's very well controlled, you cannot spread it. So number one strategy is to make sure everybody has an undetectable viral load. Or the second program is the prep program that you're talking about and prep stands for pre-exposure prophylaxis. And this is a program where you can take a medication to try to prevent your body from getting HIV.
If you come into contact with someone who has HIV.
Prakash Chandran: And is there a certain time horizon, which you need to take this if you come into contact with someone with HIV?
Mackie King: Yeah, so those are two different things. So the pre-exposure prophylaxis is kind of planning ahead. So you can either take this every single day, which is really what I recommend, or there's another strategy where if you know you're going to be having encounters, you can kind of take it based off of that. the other question you have is something that we called pep, which is post-exposure prophylaxis, which means, you know, I may not have anticipated coming into contact with somebody who had HIV.
So now I have to take medications to try to prevent that. So two slightly different things that we're talking about there.
Prakash Chandran: Okay. Got it. Thanks for that clarification. So when we're referring to PrEP, who are the best candidates to take it?
Mackie King: So the best candidates are you're a gay or bisexual man, and you have an HIV positive partner who does not have undetectable viral load or if you have multiple partners or if your partner has multiple partners. So they may be a good candidate, particularly if you’re not using condoms for PrEP.
If you’re heterosexual and you have an HIV positive partner, or again, you have multiple partners or your partner has multiple partners and they don't use condoms, you might also be a candidate for prep. And then the last category is if you are someone who injects drugs, if you're an IV drug user, then that's another way that HIV can be transmitted.
So it can be equally effective. If you continue to take prep to try to get HIV. So once we have the right people identified, it's really as simple as finding a provider who willing to prescribe prep. It is my belief that many primary care providers are fully capable of prescribing prep. It's pretty easy to do. You just have a little bit of lab monitoring and stuff. You have to keep up with my clinic. For example, we prescribe prep to anybody who is interested and looking for it. You can also Google prep providers, and you can look for someone in your area.
Prakash Chandran: Okay. That's helpful. And when we talk about this demographic of people that are good candidates for PrEP, they also happen to be the most at risk for contracting HIV. Is that correct?
Mackie King: A hundred percent. Yeah. So when we look specifically in North Carolina, like we talked about 1200 new cases in 2018, 65% of that population was African-American and 65% of those were men who had sex with men. And we're also seeing them occur in the younger demographics. So between 20, the early twenties, maybe even late teens to 30. Our primary population is men who have sex with men and disproportionately affects the African-American community.
Prakash Chandran: Okay. Understood. So, you know, in talking about this prevention, if someone is listening to this and they do fall into one of the demographics that you mentioned, your best advice would be talk to your primary care physician, get prescribed PrEP and take it consistently like on a weekly basis. Is that correct?
Mackie King: Yeah, so the prep is one pill every single day, for you to take and, you know, some primary care providers feel very comfortable doing this and others don't. if you’re a primary care provider doesn't, then I would encourage you to find a provider by Googling a provider who does so. For example, we prescribe PrEP at NHRMC Physician Specialists. You can make an appointment with myself or someone else who are in. We can have that discussion. So once you get prescribed prep, it's one pill a day, it's called either Truvada or Descovy and you take this one tablet every single day. All you have to do from there on out is have an appointment about every three months with your provider. We have appointments so that we can make sure that you indeed have not come into exposure with HIV. So when I see a patient, I'll test them for HIV every three months, I'll just do safety monitoring. double-check and make sure their kidneys are okay. Everything seems to be looking fine. And then based on kind of their, sexual habits.
We may screen for other diseases as well, like syphilis or gonorrhea once or twice a year, because it's important to note while prep is great for HIV, it does not prevent other sexually transmitted infections like syphilis and gonorrhea. Only condoms can do that.
Prakash Chandran: So I was just curious as to why other providers are hesitant to prescribe it. Are there side effects that people should be aware of?
Mackie King: Well, yes, so every medication has side effects. There's no doubt to that. you know, it's my belief that looking at the two options, Truvada and Descovy, you know, Descovy was created because it has a little bit safer profile then Truvada, but again, both of them are okay. You know, if your listeners go home and Google it, they're going to read stuff about kidneys. They'll see stuff about affecting the bones. And those are very valid concerns, which is why we do that safety monitoring. So I make sure that we're checking our patient's kidneys to make sure that they're functioning just fine. And if we ever were to see any signs that they weren't, then we could stop the medication.
I think that some providers are really just unfamiliar with it. You know, it's not something that they may feel comfortable having that conversation with their patients. And because of that, it may not even get brought up. You know, sometimes it's hard to have these conversations with patients about sexual behaviors, unless you've kind of had that specific training.
Prakash Chandran: Okay. That makes sense. And one of the things I wanted to address is that there's going to be people listening to this that have already been diagnosed with HIV. What recommendations might you have for them?
Mackie King: Yeah. So at NHRMC Physician Specialists, we have an HIV primary care clinic and, you know, we're always willing to accept new patients and happy to providing care. if you are diagnosed and you do not have medications, I encourage you to find a provider as soon as possible because those medications they're so well tolerated nowadays, compared to what they used to be.
And if you get on medication early, like I said before, you can virtually live a completely normal life from there on out.
Prakash Chandran: Okay. Good to know. Just before we close here, is there anything else that you'd like to share with our audience about HIV prevention or the PrEP program?
Mackie King: the only another word that I would mention is, you know, just everybody should know their status. So if you have the opportunity to get an HIV test, if you've not been tested, if your sexual behaviors have changed, it's always a good time to get tested. So if you know your status, then you can pursue appropriate treatment.
If needed.
Prakash Chandran: Well, Dr. King, thank you so much for your time today. It's been truly informative. That's Dr. Mackie King, a clinical pharmacy specialist at New Hanover Regional Medical Center. To schedule an appointment with Dr. King call at (910) 662-9300. Or visit NHRMCphysiciangroup.org to learn more about the practice.
If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been Healthy Conversations, the podcast from New Hanover Regional Medical Center. Thanks and we'll talk next time.