Transcription:
Prevention, Treatment, and Testing for HIV/AIDS

Melanie Cole: Welcome to Back To Health, your source for the latest in health, wellness, and medical care. Keeping you informed, so you can make informed healthcare choices for yourself and your whole family. Back To Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole and I invite you to listen to this very important panel discussion as we talk about HIV/AIDS awareness, testing, prevention and National HIV Testing Day. Joining me in this panel is Dr. Gregory McWilliams, he's an instructor in medicine at Weill Cornell Medicine and an assistant attending physician at New York Presbyterian Weill Cornell Medical Center; and Dr. Benjamin Scallon, he's an assistant professor of Clinical Medicine at Weill Cornell Medicine and an assistant attending physician at New York Presbyterian Weill Cornell Medical Center.

Gentlemen, I'm so glad to have you with us today and what a great and very important topic we're discussing today. Dr. Scallon, I'd like to start with you. Can you give us a little overview of what's going on in the world in regards to HIV and AIDS today? The remarkable success that we've had over the past bunch of decades in reducing HIV-associated morbidity, the quality of life for people living with HIV. Tell us what's going on right now.

Dr. Benjamin Scallon: I think you're right. We're light years ahead of where we were when the AIDS epidemic started in the 1980s, when we were really dealing with something that was scary, completely new and novel and essentially amounted to a death sentence for people who were infected with HIV. Obviously, we've come a long way since then. Probably, the biggest improvement and breakthrough that we've had is the advent and treatment of HIV with highly active antiretroviral therapy, which has really given excellent quality of life to patients who are infected with HIV, that has been the biggest breakthrough over the course of the past three to four decades in terms of treatment for HIV has revolutionized the field.

So of course, we're here to talk about more than that. There's a lot of new and exciting things and a discussion about completely eradicating HIV within the next 10 years, hopefully, per the goals set out by the WHO. So we're in a really exciting place when it comes to HIV treatment and HIV prevention, and so happy to talk about it.

Dr. Gregory McWilliams: And just to add on to what Dr. Scallon said, to put this in a little bit more context, upcoming on June 5th actually marks 40 years since the first initial cluster of what would be known as AIDS. It was reported in a CDC publication. So over 40 years, we've come such a long way in terms of first identifying what HIV and AIDS actually is, to now actually making it a chronic manageable disease that can be treated over time.

Melanie Cole: Dr. McWilliams, I'm so glad you made that point, that it's more of a chronic condition that can be managed these days. But is there still a stigma, do you think? Do some people think AIDS isn't really around anymore? Have you found that when you speak about this, people are rather surprised to even hear about it anymore?

Dr. Gregory McWilliams: When I see my patients in the office, oftentimes my patients that are HIV positive, it's one of the last thing on the list that we talk about because it's such a chronic manageable disease. But to put it in perspective, you know, 38 million people worldwide currently live with HIV and AIDS. And as of 2018, 1.2 million people in the United States were HIV-positive. So this is still a very prevalent issue.

I think people are talking more about their HIV status and disclosing it to their families and friends and their employers, but still the stigma persists in terms of, "Can I get HIV from this person? What does this mean that this person has HIV?" So there's still some stigma surrounding being HIV positive, which is unfortunate.

Dr. Benjamin Scallon: And if I could add on to that, I think there's less of a platform nowadays for a lot of the political religious firebrand type of stigma that existed back in the 1980s, which was a lot of, "Well, HIV is punishment for deviant practices" and I there's less of a platform for that now, fortunately.

I would say that for the patients that I've taken care of who've had HIV or who I've screened and diagnosed with HIV, there's still a lot of fear coming out to family and their close relationships as to whether or not they'll still be accepted. So I would say that stigma has gotten better probably on a national level, but still exists in pockets and still exist individually within families. So there's no doubt that it's improved, but still a long ways to go.

Melanie Cole: well, Dr. Scallon, then as you're speaking about that, what are some of the major challenges that still remain? Are young people still having this conversation about AIDS and HIV status? Speak about some of the challenges that you are envisioning happening right now that you see are happening right now and even some theories that you have or ways that you have to overcome some of those challenges.

Dr. Benjamin Scallon: Yeah, so I think that now definitely young people are seeking out testing and screening more often than when they were. I think I have a little bit of a more unique perspective on this because, before I came to Weill Cornell, I worked in pretty darn rural Pennsylvania, which is obviously an entirely different environment compared to New York City, where we dealt with a lot of chronic infections, hepatitis C and HIV, largely born out of the opioid pandemic and as a result of IV drug use. And obviously, there's still a lot of stigma regarding drug addiction amongst persons who use drugs. So there's a lot of fear about seeking treatment, whether or not you'll be accepted by your family members.  

I think that oftentimes people are concerned that their family will view them as being at fault for contracting the virus. And obviously, that's unhealthy and anyone would be fearful of being labeled as being at fault for that. So I think that's a lot of where the fear comes from. In a more accepting or tolerant place like New York City, I think that my experience thus far has been a lot of people are seeking out treatment, a lot of people are seeking out screening. And that's exactly the type of healthy environment that we want in order to eradicate this disease.

Melanie Cole: I agree completely. And that was a really good answer. So Dr. McWilliams, tell us about knowing your status as Dr. Scallon is saying people are more willing, certainly in the bigger, more tolerant cities, to come in for testing to have these discussions. Speak about knowing your status, the best way to test for HIV these days, what you would like people to know about National HIV Testing Day, confidentiality. Kind of bring that all around for us in testing and what's involved in that these days.

Dr. Gregory McWilliams: Yeah. So it's a great question. So this is something I talk about with all my patients when they come to see me for their yearly physicals or their wellness visits. And the CDC recommends, and I recommend this as well, that every adult get tested for HIV at least once, and then more frequently for certain populations, such as men who have sex with other men, people who inject drugs, people that have new sex partners. So these are things that we talk about with our patients on a daily basis.

It's really important to know your status. And one of the big mantras that's going around nowadays, at least New York City, is this concept of U equals U or undetectable equals untransmissable. And essentially, what that means is based on large studies of HIV-positive patients, patients that are undetectable cannot transmit the virus to patients that are HIV negative. So that's why we want patients to know their HIV status because if they ended up being HIV-positive, we can put them on treatment, so they end up being undetectable and therefore not transmittable to their partners or others.

In terms of confidentiality, in New York state, HIV testing is voluntary and the results are confidential. I will say a lot of these laws regarding HIV testing and confidentiality vary from state to state. But at least in New York, HIV testing is voluntary and the results are confidential and it's illegal to discriminate against a person due to their HIV status.

In some locations throughout the country, you can actually get anonymous HIV testing without giving your name. But one of the key ways to end this pandemic is those people that are HIV-positive, making sure that they're aware of that, so then we can treat them and then they are undetectable.

Dr. Benjamin Scallon: Yeah. And I'll just add in there too, that we still think that about one in seven patients who have HIV are not yet diagnosed, meaning that they have the infection, but have not been tested positive yet. So they're unaware of their diagnosis.

Melanie Cole: Well, thank you for that, gentlemen. So Dr. McWilliams, what's exciting in the field of HIV treatment. I'd like you to talk about PrEP because you mentioned off air that this was an interest of yours. And so tell the listeners what that is, what patients might consider it. Tell us how exciting this particular innovation is.

Dr. Gregory McWilliams: So HIV PrEP or pre-exposure prophylaxis is one of my clinical interests and something that excites me deeply. Essentially, it's a daily pill that individuals at risk for HIV take to prevent acquiring HIV. Nowadays, the treatment is so effective, well over 90%, approaching 100% effective in preventing HIV.

Certain patients that may want to consider PrEP would be patients that are in a serodiscordant relationship, so that would be one of the partners is HIV-positive and one is HIV-negative to prevent HIV transmission to the HIV-negative partner. Men who have sex with men, people who inject drugs, people who do commercial sex work, these are all indications for HIV pre-exposure prophylaxis.

It usually involves maintaining a very close relationship with your doctor, where you are seeing your physician or provider, nurse practitioner, physician assistant, every three months to check in about how the medication is going and to do some routine lab work. But overall, it's a game changer and it’s reduced the number of HIV transmission events in the US, particularly in New York City. And it's a very exciting development.

Dr. Benjamin Scallon: I agree with all of that. It is very exciting. I would just point out again that the best way to reduce transmission is to effectively treat people who have HIV and bring them down to undetectable levels. As Dr. McWilliams alluded to earlier, U equals U, right? Undetectable means untransmissable. And PrEP is a very useful tool in order for us to reduce that risk even further. So I agree, it's very exciting. We think that we have all the tools we need to eradicate HIV, PrEP being one of the tools that we have.

Dr. Gregory McWilliams: Just to comment a little bit on HIV treatment, in terms of treating patients that are currently HIV-positive, the treatments compared to what they were 20 years ago are much more safe and effective, and they also have much less of a side effect profile. So now, if you think about how far we've come, where some of these patients in the late '80s, early '90s would be on cocktails of multiple medications that they had to take multiple times a day that had profound side effects that impair their quality of life. And now, we're at the point where patients are on one pill a day with very minimal side effects that completely suppress the virus. So just looking at treatment over the past 20, 30 years has been remarkable.

Dr. Benjamin Scallon: I think that these medications are so safe and effective, that I would be hard-pressed to think of a patient for whom I wouldn't give this medication if they asked for it with regards to the PrEP. So I agree. I think it's very exciting.

Melanie Cole: Well, it is. And also due to the fact that there isn't this huge cocktail that we used to hear about that was really pretty scary for people to think about that type of treatment and those side effects. So, Dr. Scallon, what action in your opinion is still needed to stem the increase in AIDS cases? I'd like you to speak about risk reduction a little bit, and maybe even what some other countries have done that you are impressed by or that you think that we could be doing more of here.

Dr. Benjamin Scallon: I think that there are a few overseas example that can illustrate what we can do more effectively. I think a good case study is the difference between some countries in Southeast Asia, namely Thailand and Philippines, which have kind of gone in divergent directions over the past decade or so. Thailand, although their laws regarding drug use are not exactly lenient, they're certainly loosening compared to their neighbor in the Philippines. And what they've seen there is actually a dramatic reduction of new HIV infections with things like needle sharing or accessible PrEP for sex workers, as opposed to the Philippines, which has developed, you know, more draconian laws regarding drug use and has further stigmatized the population that's most at risk. I think the same could be said in Russia where there's a lot of stigma regarding drug use and homosexuality.

So the Philippines and Russia are places where the HIV infection is rising. It's a pretty stark example between what tolerance means and how do we work with patients to reduce risk instead of being punitive and punishing.

Dr. Gregory McWilliams: Also, on a very similar related note to what Dr. Scallon has said about how the world is approaching HIV nowadays, we have to put this in context of the recent COVID pandemic in that COVID testing, treatment, quarantine protocols have overwhelmed National Ministries of Health, Departments of Health worldwide, and HIV testing and treatment efforts have been put on the back burner. So I think it’s important as we start to emerge from the COVID pandemic, is we don't forget about the HIV pandemic that may have been left on the back burner and making sure those efforts are accelerated moving forward.

Melanie Cole: Doctors, I'd like to give you each a chance for a final thought. And this is such an important topic that, as you said at the beginning, I don't think it's talked about enough these days. So let's do that. Dr. Scallon, I'd like to start with you. Please tell the listeners what you would like them to know about HIV testing and awareness and AIDS awareness, risk reduction, anything you would like to tell them about AIDS and HIV right now that is hopeful and exciting in the field. What would you like to tell them?

Dr. Benjamin Scallon: The biggest thing that I'm excited about is that we're talking about completely eradicating the infection at this point, that the standards and the goal from the WHO right now is to eradicate HIV by 2030. It's going to require a lot of work. It's going to require that we utilize all the tools that we have available to us now. I think the message I'd like to get out to patients is HIV is very treatable. Patients who are treated with our current antiretrovirals have life expectancies and quality of life that approach what you would expect if you did not have HIV. And I think it's very important that we as healthcare professionals really meet patients where they're at and find out ways to use tools that we have to really reduce risk that includes not stigmatizing and making sure that we're here and supporting patients and contributing to an environment of tolerance and inclusion.

Melanie Cole: Dr. McWilliams, give us your final thoughts on getting the word out and awareness and PrEP and your interests here and why it's so important that we all know our status and keep the conversation going.

Dr. Gregory McWilliams: So my message about PrEP is that PrEP is a game changer. It's incredibly effective in preventing HIV transmission, and it's a very safe drug with minimal side effects that can really help you prevent HIV transmission going forward. The number one thing I want to tell my patients is know your status, know your HIV status. If you're not infected with HIV, we can talk to you about how you can learn to stay that way whether it involves PrEP. And if you do happen to be infected, we can also talk to you about safe and effective treatments that have a limited side effect profile that can help you have a normal life expectancy and quality of life.

Melanie Cole: Such an informative episode, gentlemen. Thank you so much for joining us today and sharing your incredible expertise and passion on this topic, because we can certainly hear that. So thank you so much.

And Weill Cornell Medicine continues to see our patients in person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Back To Health. We'd like to thank our listeners and invite our audience to download, subscribe, rate, and review Back To Health on Apple Podcast, Spotify and Google Podcast. For more health tips, please visit weillcornell.org and search podcasts. We have so many interesting podcasts in the library. And parents, don't forget to check out our Kids Health Cast. I'm Melanie Cole.

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