Scott Webb (Host): World AIDS Day is December 1st. And on that date, and every day really, Summa Health wants to raise awareness of HIV and AIDS. And joining me today to help accomplish this goal is Dr. Amy Hite. She's the Director of Summa Health System's Center for AIDS Research and Education.

This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Dr. Hite, thanks for your time today. We're going to talk about and sort of help folks navigate the world of HIV and AIDS. And we know that World AIDS Day is December 1st, and sort of in honor of that and respect of that, we're going to kind of break things down for folks today. So, let's start there. What is HIV and how does someone contract it?

Dr. Amy Hite: HIV stands for human immunodeficiency virus. The virus is spread mainly through blood and other bodily fluids like semen or vaginal fluids. Some things it's not spread through, urine, tears, saliva. So, some body fluids, not spread; some, it is. I would say the main modes of transmission in general are from sexual contact and sharing of used needles. Rarely, somebody may have an exposure at work in the healthcare settings such as a needlestick from a patient who is living with HIV. Overall, in most countries across the world, including the US, HIV is transmitted through sexual exposure primarily. In the United States, men who have sex with men make up the highest number of cases, but there are many heterosexual persons, including women, who are acquiring HIV.

Host: Yeah. And how does HIV become AIDS?

Dr. Amy Hite: That's a good question, because I think some people automatically think that HIV and AIDS are the same thing, but that's not true. So, HIV, the virus, can slowly affect the patient's immune system and it can weaken it over time. So when the immune system is affected in a significant way, then that is defined as AIDS, which stands for acquired immunodeficiency syndrome. So, not every patient who has HIV has AIDS. But if the immune system has gotten weak enough, then that patient may have HIV infection and AIDS. When someone has AIDS, they're at risk for the development of many different infections and illnesses that someone with a normal immune system wouldn't normally get.

Development of AIDS is a slow process. And on average, it takes about 8 to 10 years from the time of infection to the development of AIDS. This is however without treatment, so not every person who has HIV is necessarily going to develop AIDS. And that's the reason that early diagnosis is so important, because we can prevent AIDS from ever happening. And even if someone develops AIDS from HIV infection, they can still get better and improve their immune system back to those normal numbers. Again, that's why talking about HIV and getting tested is so important.

Host: Yeah. And, you know, for those of us who lived through sort of the beginning of all of this, the beginning of HIV and AIDS, it seemed like it was in the news a lot and talked about a lot. It seems like folks don't talk as much about HIV and AIDS today. And I guess I just am wondering, do people still get HIV?

Dr. Amy Hite: Yes, of course. And as you said, it is something that maybe isn't discussed as much. I think that is in part because we have a lot of great treatments for HIV. And so, it's not the death sentence that it once was, and so I think because of that, we don't have as many discussions about it. But unfortunately, yes, there are still many people getting HIV each year, not only in the US, but across the whole globe. Despite all of our knowledge about how we can prevent transmission, you know, we still have many, many new cases every year. They are declining though, which is a good thing. But we still see, I would say, between 30 to 35 new HIV diagnosis each year in the United States, and countries across the globe still seeing many new cases as well. There were 1.3 million new cases of HIV across the globe last year. Most of these in the US are in young people and persons of color. But it's important to remember, we must remember that anyone of any age, any person is at risk of getting HIV.

One reason there's a lot of new cases is that many of these new infections are spread from people who don't know their status. That's why HIV testing is so important and every person should be tested and know their status regardless of how much HIV risk that they think that they have.

Host: Yeah. So, let's talk about that knowing your status, right? It would presumably begin with knowing experiencing some signs and symptoms. So, what are the symptoms of HIV?

Dr. Amy Hite: So, they can be really varied, and that's because of a couple reasons. One is that HIV can affect the whole entire body in a lot of different ways so that it can manifest symptoms in different body systems. And the other reason there's a lot of different symptoms is that, like we said, HIV is an illness that someone has for a very long time. So, it has different stages of illness. So in like the early acute stage, when someone first gets HIV, the patient mostly might have a flu-like illness. So, they would have symptoms of like fever, rash, swollen lymph nodes, sore throat, sweats, things like that. And that will just last a week or two, and it'll resolve. Then, after those go away, honestly, most people who are living with HIV are asymptomatic for a long time until they might be getting sicker and developing AIDS, like we were discussing. This is one way that HIV continues to spread a lot because during that asymptomatic time period, which can last for years. The person doesn't realize that they're living with HIV and they may be, you know, spreading the infection.

So again, it's important for healthcare providers to discuss testing with patients at all possible stages of the disease because diagnosis is really key no matter what stage the patient is in.

Host: Yeah. And I know this question I'm going to ask you next here. I know the answer at one time would have been absolutely no, absolutely not. But today, I'm wondering, is it safe to have sex with someone who's been diagnosed with HIV?

Dr. Amy Hite: That's a great question. And I think this is a very good topic to talk about. And truly, it depends. So, it is true that sexual transmission is the main way that HIV is spread as we discussed. However, there are a lot of ways to prevent sexual transmission and these tools are very, very effective.

The first way is simply to use condoms if you're sexually active, which we advise anyway. And condoms are very good at preventing HIV transmission. And the other positive thing about condom use is that they also help prevent the spread of other sexually transmitted infections like chlamydia, gonorrhea, syphilis. Because if someone gets another sexually transmitted infection, it could increase the chance that they may get HIV.

The other way to prevent HIV transmission is through the use of PrEP, which is pre-exposure prophylaxis. This is taking medicine to prevent getting HIV, and it works very, very well. It's over 99% effective at preventing HIV transmission. So if someone who is on PrEP has sex with somebody who has HIV, the chance of them getting HIV is extremely low.

And then, really, one of the best prevention tools that we have is having HIV patients on HIV medicine. These medicines are very effective. And if taken correctly, the patient's virus will be suppressed to really, really low levels, which we call being undetectable. And multiple research studies have shown that if someone living with HIV is on medicine and undetectable, they will not transmit HIV to their sexual partners. We call this concept U equals U, which stands for undetectable is untransmittable. I think it's important for us to all understand this concept because it can help try to reduce some of the stigma associated with being HIV positive. And it can also validate the importance of knowing one's status and being on treatment.

Host: Wondering, is it possible for HIV to pass from mom to baby?

Dr. Amy Hite: So, yes, similar to what we were just discussing, without the proper prevention tools, HIV can be passed from mother to child with pregnancy. Most of the time this transmission occurs at delivery actually, like during the process of delivery, but also can sometimes occur like during the pregnancy itself, although that's less common.

Without any prevention, this occurs at a rate of about 1 in 4 pregnancies of women who are living with HIV, so a rate of about 25% of the time, but that's without any prevention techniques. Fortunately, we have ways to prevent this. And as expected, the main one would be for the mother who is pregnant and living with HIV, to be on HIV medicine and be undetectable. If this occurs, the chance of the baby having HIV is probably about 1% or less. And then, HIV medicine can be given during delivery to the mother and then to the baby takes HIV medicine for a while after being born to help prevent HIV transmission. And due to all of these, all of these prevention strategies, there are very, very few mother-to-child transmission cases anymore in the Us.

Host: Right. I know the answer to this question, but good to hear it from an expert, is there an actual cure for HIV and AIDS, or is it really, as we were discussing here, just about the treatments and being undetectable?

Dr. Amy Hite: Really, I would say, in general, I'm going to answer this, no. There have been a few very unique circumstances of cure in HIV. But in terms of an actual true cure that can be broadly applied to the millions of patients living with HIV, no. Due to the nature of the HIV virus, it is very, very hard to cure completely because part of the virus stays with the patient and is hard to get to. This is different than some other chronic viral infections like hepatitis C, for example, which can now be cured.

There is a lot of ongoing research though in the area of HIV cure and trying to get to that virus that is hard to reach. But, as we've mentioned though, there are very good treatments. Like you were saying, patients can be on medications and live long, healthy lives. And these medicines have improved considerably over the last 30 years or so. They're easy to take. They have very few side effects. They're extremely effective as long as the patient takes it regularly.

Most patients nowadays, I would say, are taking one pill a day to control their HIV. There's also long-acting injectable options. They can come to the office and get a couple injections every eight weeks to manage their HIV. With these types of treatments, a person living with HIV can expect to live a normal life expectancy, and as you said, do all of the things that anyone else can do with their life.

Host: Right.

Dr. Amy Hite: I sound like a broken record, but that's why it's so important for everybody to know their status, be tested for HIV, get diagnosed as soon as they can, and get on medications because we have the tools to either prevent if you're negative, we want to keep you negative; and if you're positive, we want to get you into treatment, because we have very effective medications now.

Host: Well, doctor, thanks so much for your time today. I think it seems like COVID has sort of stolen the headlines a little bit, and we don't talk as much about HIV and AIDS. But it's good that we're doing that today. I'm sure listeners appreciate it. So, thanks so much and you stay well.

Dr. Amy Hite: Thank you. You too. Thanks for having me.

Host: Get screened to know your status. Learn more at summahealth.org/care-center. And if you enjoyed this episode of Healthy Vitals, we'd love it if you'd leave us a review. Your review helps others find our educational content. I'm Scott Webb. Thanks for listening, and we'll talk again next time.