HIV, Dr Maggie Hoffman, Access discussed on Short Wave
Today we're talking about the progress that has been made in HIV treatment. Over the past three decades. Dr Maggie Hoffman. Terry has spent the past five years researching HIV and providing care to patients living with the virus once we started to understand you know the basics about HIV before we had any treatments. Tell me a little bit about what that time. Period was like I think very scary because initially we didn't know even how HIV have you were spread. My first exposure to it was as a pre medical student. I went over to a local hospital and worked with the infection. Doctor there but he he took me in to see two cousins who both had. HIV and held their hands without gloves. Because he said Is that I think it would be a terrible thing saying to be alone and to not be able to touch someone and to be the sick Because they were both dying and beyond that they just didn't know what to do except to keep people going as long as you could They used lots of different palliative kind of things things that we use said end of life to this day with cancer patients but that was all that was available to us and really so the first ray of hope was really. AZT The first drug. That was it was used to treat it. That is true. I remember the posters of vividly from my third year of medical school with an alarm clock on that said. If you're willing to get up every four hours and you have AIDS. We have a drug for you. I went to medical school and Temple North Philadelphia which was very hard hit area the AIDS epidemic even early on and people were lining up to get this magical drug even if it meant you got up every four hours to take at least a gave people finally some home before we talk about how. HIV drugs work. You need to know a couple of things. Our immune system is made up of all kinds of different cells. One type called T.. Cells specializes in protecting our bodies from viruses like HIV Maggie calls HIV a smart virus because it specifically attacks those t cells basically the virus kills the very cells that are trying to hunt them one way. HIV kills t cells is by hijacking genetic machinery Henry inside those cells forcing the cells to bake more and more copies of the virus eventually bursting out of the cell killing it so easy t- The first major drug targeted. HIV Pretty early on in its viral. Life cycle disrupting this process. The problem was that easy T- worked for a few months but in and of of itself as a single agent the virus was smart enough to get around it so it improved things for a few months but it never improved things in in the long run right that continued I did my infection fellowship. Nineteen Ninety two to one thousand nine hundred ninety four and it was still similar. At that time you were are uniformly telling young people time and again That they were going to die and that they should get their fares in order that they had children we would get them to meet with a case manager to figure out who was going to raise their children It was just a terrible. I can't I can't imagine what that was like. I think what often kept us going was the dream that better treatment would come along and we were fortunate enough in our fellowship to be involved in nearly nearly studies on protease inhibitors. So let's talk about that because that was another big Development and other big moment in this treatment was the development of heart and protease inhibitors. So talk to me a little bit about those so. HIV is like snowflakes in the body every time it divides it mutates at at least one spot and by doing so no to viruses in the body your body if you're infected with HIV. No two viruses viruses are alike in that way it is able to figure out how to get around easy T- so what we did was we developed drugs that hit hit from other targets and we're more potent So hard stands for highly active antiretroviral therapy And by combining signing three drugs that were working you know usually at least two different angles two different ways and the body We were able to finally finally get the virus. All the way controlled. Get it down to what we call. Undetectable but if we stopped the medicines it will come back but but having said that many of them were anywhere from ten to eighteen pills a day and they often cause side effects such as nausea vomiting meeting And leipold dystrophy which was this redistribution fat. But as these singled tablet regimens came out. They did not what caused these side effects. Right so that kind of brings us to the next big game changing moment around two thousand seven where you know a lot of those treatments that are a a lot of pills have become kind of one or two pills yes so the single pill once a day you know very much changed. The game from having to Rearrange Injured Day around two to three times having to ingest multiple pills so they were much better and much easier to take and greatly improve people's both compliance with the medicine the likelihood that they would take it every day and they're virus wouldn't develop resistance but improve their lifestyle also because because all they had to do was make sure they took that pill as they went to bed each night or with breakfast each morning Safer single tablet pills have come along now now containing integrase inhibitors and those are very easy and much much less toxic pills to take And I think we're really finally at the point in time That easy one pill a day combinations are here. Maggie says these treatments when used correctly and effectively also act as a form of prevention. When it comes to transmitting? HIV through sex treating HIV itself and getting that viral load down to undetectable undetectable prevents many many infections because even if patients sleeps with someone else so someone who has HIV if thyroid medication and they have unprotected sex. They are extremely unlikely to spread it to someone else If they are on medication so that's one. The type of prevention another form of prevention came in twenty twelve a strategy called pre exposure prophylaxis or prep in this case a daily pill. That's taken by people who don't have HIV and it prevents them from getting HIV from somebody else but when it comes to the latest treatments despite the real progress that's been made the issue of access is to these life. Changing medications is also very real. What what still needs to be done so that everybody that needs them has them well? The drugs need to be affordable because there have been states where the drugs have been waiting listed We have AIDS drug assistance programs and all of our states but they are federal dollars that have to be batch by state dollars and not every state matches them and Pennsylvania gene you were. I practice were very fortunate because we have a very very good extremely good program but there are many southern states where that's not the case And that has has been a problem for a while according to the US Department of Health and Human Services in twenty eighteen only sixty two percent of the worldwide HIV positive population were accessing assessing antiretroviral. Therapy and in some countries progress towards preventing new infections and increasing access to treatment is actually slowing down or getting worse but for those who do have access to care. The progress is undeniable. You know now that people that do have access to these like good. HIV drugs are living longer and healthier lives. Has that kind of shifted your role as a healthcare provider I in types of patients that you're seeing now The big pushes rushes looking at getting your patient into old age and Many of my patients I think our oldest patient currently is eighty seven But the average change our patients now is over fifty So we're looking at caring for later middle aged and geriatric population And that is much of what my care is pre you know in today's world So I admit early in that epidemic. I why it never thought I would be reading geriatric articles but that is much of what. HIV CARE is now a big. Thanks to both Maggie and and stash for talking with us. Today's episode was produced by Brett Hansen in edited by B at Les. I'm Anne Safai. Thanks for listening.