By Dr. David Gorchoff
December 1 is World AIDS Day, a great time to bring awareness to the ongoing challenge of HIV/AIDS.
Thirty years ago, when I was caring for people with AIDS, the best we could hope for was often to slow the progression of the disease. Eventually, most would succumb. Today, people living with human immunodeficiency virus (HIV), the virus that causes AIDS, can expect to live nearly as long as their HIV-free counterparts if they consistently take medication prescribed to suppress the virus.
Not only do we have excellent treatment options for people who are newly diagnosed, we also have effective treatment for those who have lived with HIV for a long time and may have a resistant strain of the virus. I hope and believe we can eradicate AIDS if we continue to support medical research and educate the public about how to reduce the spread of the virus.
We've been able to continually improve HIV treatments, prevention options are becoming more available, and recent breakthroughs in vaccine technology during the COVID pandemic may offer clues on how to produce a useful HIV vaccine.
Prevention
When it comes to HIV, prevention is the best cure. People between the ages of 13 and 65 should be tested for HIV at least once in their lifetime. Those at higher risk, including people with multiple sex partners, injection drug use, and men who have sex with men, should get tested more frequently. People who are HIV-positive should tell their sex partners so they can protect themselves, and people who are at high risk should also consider pre-exposure prophylaxis (PrEP), antiviral medication that can prevent infection.
I encourage primary care medical providers to ask their patients about their sex lives. But because they are often pressed for time–or they are uncomfortable with the topic–they avoid the conversation, and may miss the opportunity to recommend an HIV test or inform their patient about PrEP. These types of discussions can be especially important for young people exploring their sexuality. It is always appropriate to talk to your health care practitioner about these issues.
Response to exposure
If you have a known exposure to HIV through work, sexual activity, or shared needles, you should be aware that post-exposure prophylaxis, or PEP, is available. If PEP anti-viral medication is started within 72 hours of exposure, it can greatly reduce the chance of infection.
Stopping the spread
Typically, early (untreated) infection with HIV is associated with a lot of viral replication and a high risk of passing the virus to others, so getting people on treatment as soon as possible is the goal. It decreases transmission, which is good for the community, and it preserves the individual's immune system.
In the HIV world, we have a saying: undetectable means untransmissable (or U=U). That is, if someone is consistent with their treatment and can keep their viral load suppressed to the point where usual lab tests cannot detect it, then the virus will not be passed on to sexual partners. This makes previously unthinkable things possible, including, for example, the possibility that an uninfected woman could safely get pregnant by her HIV-positive partner without putting herself or their unborn baby at risk.
Living with HIV
The key to staying healthy when you're living with HIV is to be consistent about your anti-viral medication. This used to require several doses a day and come with unpleasant side effects, but now things have evolved to the point where most folks need only take medication once a day and there's a low risk of side effects or toxicity.
Lately, there's been a lot of advertising around injectable anti-viral medication. To be clear, the injections are no better than taking pills for viral suppression. If you cannot (or do not want to) swallow a pill, you can opt for the injections, but know that timing is important in terms of getting the (two) shots every 1-2 months and most patients find the shots uncomfortable.
Although I am so happy we can reduce people's viral load so they can be healthy and avoid infecting others, I still think communication is important and would recommend that people living with HIV discuss this with people in their lives, including family members, friends, and sexual partners. Some HIV-negative partners who are aware of their partner's HIV-positive status choose to use PrEP. It's a way to share the responsibility of protecting themselves.
If you or someone you love is at risk for HIV, please get tested. If you test positive with a quick saliva swab or a blood test, we can enroll you in treatment right away. The sooner you get treatment, the more likely you (and those close to you) are to have a good outcome. If you're worried about the cost of care, don't be. MCHC Health Centers is a federally qualified health center that receives funding from the Ryan White Program. We do not turn anyone away because of an inability to afford care.
Dr. David Gorchoff is a physician caring for patients enrolled in the Ryan White Program at MCHC Health Centers—a local, non-profit, federally qualified health center offering medical, dental, and behavioral health care to people in Lake and Mendocino Counties.
No comments:
Post a Comment