Treating and preventing HIV infections was the topic of a recent interview on CHI Mercy’s Talking Health program on News Radio 1240 KQEN.
Host Lisa Platt interviewed Renée Yandel, the executive director of the HIV Alliance and Geoff L’Heureux, HIV clinical pharmacist at the HIV Alliance about the new developments in fighting, treating and preventing HIV.
The following is an edited version of that interview on KQEN from July 16.
Lisa: What are the services that the HIV Alliance provides?
Renée: Our mission is to provide care for people living with HIV and prevent new infections. We provide care coordination services for about 1,000 people with HIV, in 13 counties in Oregon, including Douglas County.
Our model is really one of holistic care , and we offer everything from pharmacy to emergency housing assistance.
On the prevention side, we focus on things that are evidence based. We offer free HIV testing, free Hep-C testing, and we have a syringe exchange. In addition, we have a fantastic program to educate the community about preventing HIV, and reach everyone from youth in the schools to folks accessing drug treatment.
Lisa: What is HIV, how is it transmitted and how does it affects the body?
Geoff: HIV is a specific kind of virus that we call a retrovirus and it’s transmitted mainly through unprotected sex. It can be transmitted by sharing injection drug supplies like needles, and in rare cases transmitted from mother to child during delivery or breastfeeding if the mother is HIV positive.
It’s really important that people understand that HIV is not spread through casual contact, so shaking hands, hugging, kissing, sharing food utensils, things like that, and most body fluids, unless they’re bloody, are not infectious for HIV.
Once the HIV enters the body, it looks for a specific immune cell we call the CD4T cell. It gives instructions to other immune cells and tells those how to fight complicated infections.
As HIV infection progresses, we start to lose the CD4T cells that are in charge. We still have frontline fighters, and immune cells that are protecting us against other viruses. But when an infection or even a cancer becomes complex, we lose the ability to launch a coordinated attack on those. That’s where the problems with HIV come from.
Lisa: Since the beginning of the epidemic in the 70s and 80s, how has medication evolved since that time?
Renée: When I started several years ago, people were taking piles of medications. We would go into a community to do a presentation and I would take this huge jar and tell people this is one month of medication, and about $2,500 a month. That jar has gotten down to one pill a day in some cases.
We do still see long-term survivors who have a lot of other complicated chronic conditions and they are still taking a lot of medications for those other conditions. But for the treatment of HIV, it’s generally just one pill now.
The medication regimens are still incredibly expensive, completely inaccessible for most people if you don’t have medical insurance or are wealthy.
Geoff: In addition to just the amount of medications people had to take before, we also saw a lot of drug interactions and side effects. That jar full of pills had to be taken on a very strict schedule. Now, 17 years later, most of our patients take just one tablet a day and that contains their entire dosage.
It’s so much easier because they have to schedule events around the time they have to take medication.
Lisa: When the doctor says the virus is undetectable, what does that mean?
Geoff: In a very strict sense, it means that the tests can’t find any copies of the HIV virus in the blood. The HIV virus takes its genetic information and incorporates it into the DNA of the cells that it infects.
So even though we don’t have any HIV floating around in the blood, there are some cells that harbor the genetic information. That step is why we cannot cure HIV at this point.
Without having a circulating virus, that means the immune system can relax, and can become stronger. It also means the risk from other health complications from chronic inflammation goes down as well, so risks of cardiovascular disease, diabetes neuropathy, all those go down.
There have been some studies recently that have shown that people whose virus is suppressed on medication and have an undetected viral-load, cannot transmit HIV to other people, even through high risk behaviors, including sexual contact.
There is a big push led by the CDC right now to get people to undetectable to make sure they’re not transmitting.
Lisa: Those individuals continue on that medication even though it’s undetectable?
Renée: Yes, there is no cure and you will be on treatment for the rest of your life. In our care, about 94 percent have undetectable viral load.
Lisa: Would you talk about a prevention medication that has recently evolved?
Geoff: There is medication that is approved to prevent HIV, a combo pill called Truvada and right now it’s the only thing that’s approved for what we call pre-exposure prophylaxis, or action taken to prevent disease, especially by specified means or specified disease.
This is a game-changer. We now have an effective tool to prevent HIV. The only downside is that is still very expensive.
Truvada is looking at going generic soon, but there are numerous drug assistance programs, and our navigator at the HIV Alliance can help people figure out their options.
Lisa: Do you still have challenges for people who acquire HIV?
Renée: One of the primary things we see, has to do with the determinants of health. The majority of people that come to the HIV Alliance for care, are at or below the poverty level, so it’s hard to make ends meet.
One of the things we’ve done is utilize an employment specialist who can help people get back to work and we’ve had remarkable success.
Geoff: Even though HIV is manageable, we do see that people living with HIV do get chronic diseases of aging, high blood pressure, high cholesterol, and diabetes at increasing rates and at younger ages than people who don’t have HIV.
Lisa: What are you doing to prevent a HIV in Douglas County?
Renée: We have an office here (on West Luellen Street) and we provide free HIV testing Monday through Friday. We can provide a free rapid HIV test.
We also provide free screening for Hep-C at the office and we have the syringe-exchange program, so folks can bring in used syringes and get new supplies. They can get referrals to treatment and we have overdose prevention counseling that we can provide.
We do both adult and youth education in Douglas County schools.
Lisa: What is the process of the HIV test?
Renée: It’s really easy, either a finger-prick or an oral swab. We conduct the test and 20 minutes later we will deliver the results. If someone tests positive, we can connect them to care right there. That really goes a long way to making sure everyone is getting treated, viral loads are suppressed, and we have fewer overall new infections.
For more information, visit the HIV Alliance website www.hivalliance.org or call 541-342-5088 for information.