MedLink Health Connections Podcast

Preventing HIV Today: Testing, PrEP, PEP, And Primary Care’s Role with Dr. Cameron Wagenbrenner

• MedLink Georgia • Season 1 • Episode 23

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Many people still hold outdated beliefs about HIV, leading to fear, missed testing, and preventable infections. In this episode, Dr. Wagenbrenner, an internal medicine physician at MedLink, breaks down the essentials—how HIV affects the immune system, how it differs from AIDS, and why accurate information saves lives. We cover national and Georgia-specific stats, real transmission risks, and the common myths science has long disproven.

We also dive into today’s prevention tools: safer sex practices, PrEP options like Truvada, Descovy, Apretude, and the new six-month injectable, plus PEP and the crucial 72-hour window after possible exposure. Dr. Wagenbrenner explains who should get screened, how rapid and blood tests work, and why easy access to prevention and testing drives down transmission.

Treatment has advanced dramatically, too. Many patients now take one pill a day or receive periodic injections, experience fewer side effects, and reach undetectable viral loads that protect their health and their partners. Dr. Wagenbrenner shares how primary care normalizes these conversations and supports patients without judgment.

If you learned something new, follow the show, share it with a friend, and leave a quick review to help others find trusted HIV prevention and care guidance.

SPEAKER_01:

Welcome to the Medlake Health Connections podcast. In recognition of HIV Awareness Month, we're talking about the basics of HIV, where things stand today, and the important role primary care takes or plays in prevention, testing, and treatment. Joining me is Dr. Waggenbrenner, an internal medicine physician at our Medlink Culbert and O'Coney offices, where he has been a part of our team since 2022. He studied at the University of Georgia and attended Mercer University School of Medicine and completed his internal medicine residency in Savannah. Dr. Wagenbrenner, thank you so much for being here. Can you explain what HIV is and how it affects the body?

SPEAKER_00:

So HIV is stands for human immunodeficiency virus. It's a viral illness that infects normal white blood cells, cells that we carry in our body to help fight infection, and it prevents our ability to fight infections when they're presented to us.

SPEAKER_01:

Okay, and how is HIV different from AIDS?

SPEAKER_00:

So AIDS is a severe stage or sometimes considered an end stage of HIV virus. As HIV persists in the body, it does decrease certain white blood cells called T cells. And when these levels get low enough, patients can have complications from inability to fight infections, sometimes called opportunistic infections, and even sometimes develop certain types of cancers that are seen in patients with AIDS. It's really just the progression of HIV without treatment.

SPEAKER_01:

Okay. How common is HIV today, both nationally and here in Georgia, or our community?

SPEAKER_00:

So most recent studies in the United States show about 1.2 million people in the US are living currently with HIV. In the United States, there's about 30,000 new cases of HIV per year. And about one in seven people living with HIV are do not know that they currently have HIV. In Georgia, there's estimated to be about 71,000 people living with HIV and about 2,500 newly diagnosed HIV patients in the last year.

SPEAKER_01:

Wow. So what are the main ways that HIV is transmitted?

SPEAKER_00:

So there are multiple. Probably the most common or the most common that people acquire HIV is through sexual intercourse. Secondly, is usually IV drug use. Still most prevalent amount of patient population that we see get diagnosed and acquire HIV is in men who have sex with men, followed by heterosexual intercourse, and then followed pretty far amount below that in people who inject IV drugs.

SPEAKER_01:

Okay. And are there any misconceptions about how HIV spreads that you'd like to clear up?

SPEAKER_00:

So I think the fear of acquiring HIV can uh cause people to have misconceptions on how it's transmitted. It requires encountering blood, semen, vaginal secretions, rectal secretions, or breast milk, or blood-contaminated fluids in a person living with HIV. And it has to be encountered through a non-intact skin, so with a wound or in contact with an eye, mouth, rectum, vagina, or other mucous membranes. You can't get HIV from someone who's living with HIV if you encounter contact with their urine or nasal secretions or saliva or tears. So it has to be a pretty significant interaction with someone who has HIV to be able to acquire it.

SPEAKER_01:

Wow. Okay. And what role does stigma still play in HIV prevention and care?

SPEAKER_00:

So when HIV was first discovered, there was big stigmatization about the patient populations that it was initially found in. And that's persisted for now decades since the late 70s, early 80s. There's fear that specifically men who have sex with men, there's high risk of transmission, and encountering that patient population can uh lead to higher risk for transmission. People oftentimes are very fearful to let others know that they are diagnosed with HIV. And there's concern that once you're diagnosed, that there's no treatment and it potentially could uh result in um end of life. Now, most multiple of those things that I just mentioned are either not no longer true or um the misconception can be kind of altered in a way that um we can really prevent the risk of exposure, transmission, and then improve treatment outcomes with better education.

SPEAKER_01:

And how what does that HIV prevention look like today?

SPEAKER_00:

So there are multiple different ways that we can prevent HIV. Um obviously, with highest transmission being with sexual encounters, um as previously termed like sex practices, safe sex practices, um, irregardless of medication, um, can still be very beneficial in decreasing the um possibility of transmission of HIV. And then there are a lot of oral or a lot of medication options, uh, not only oral options, but also injection options that could prevent it. Um there are two oral medications uh currently being prescribed. The brand names are Discovy and Truvata. These medicines are taken once daily and are greater than 90% effective in preventing the transmission of HIV for not only sexual encounters, but then also um potential for exposure with IV drug use. And then there are two um injection options. Uh the first is called Apertude. Uh, this is a month, uh, every two-month injection after getting two injections uh two one month apart. So every two-month injection from there. And then recently in June, the FDA came out with a new medicine called Yes2Go. Um, that's an every six-month injection for the prevention of HIV and currently being studied for potential of just doing it every year. So there's really four medicines out now that we can use to prevent HIV that are very effective. Um, it depends on patient preference on which ones we use, um, but all are very effective and if taken correctly, can really prevent or decrease the likelihood of transmission of HIV if there is uh significant risk exposure to someone with HIV.

SPEAKER_01:

Okay. So can you tell us a little bit about CREP and PEP, which I feel like you kind of did, and how they signal it?

SPEAKER_00:

Yeah, so um I think a lot of patients will come in knowing um these acronyms that are set up. PREP stands for pre-exposure prophylaxis. And those are the medicines that I um just talked about. These are medicines that you take either daily in oral form or injection every two to six months, depending on the um formulation that is used, and they help prevent the um possibility of transmission of HIV into someone who is HIV negative. PEP or PEP stands for post-exposure prophylaxis. This is in someone who has not been taking pre-exposure prophylaxis, who has had a significant exposure and increased risk of acquiring HIV when encountering a situation where they're exposed to HIV. One of the big caveats with PEP or post-exposure prophylaxis is that it has to be started within 72 hours after the exposure to be effective. And if it's not started within that time period, um, is not seen as effective and actually can be harmful in terms of not starting correct treatment if HIV is acquired.

SPEAKER_01:

Okay, well. Um, when should someone get tested for HIV and how often?

SPEAKER_00:

So currently, the recommendation from the United States Preventative Task Force, who makes rec recommendations on many of our prevention strategies in the United States, recommends that anyone over of 15 to 65, so anyone between 15 and 65 should be screened once in their lifetime for HIV. Now, in certain populations at high risk for potential of acquiring HIV, they should be screened more frequently. Those are in patients who have had a recent sexually transmitted infection, they should also be checked for HIV at that time. The patients at increased risk for sexually transmitted infections uh or potential of HIV through sexual encounters should be checked every six months to a year. Patients who inject drugs should also be checked every six months to a year. And then certain patients who are starting what we call immunocompromising or medicines that can decrease the immune system should be checked for HIV on a more regular basis as well.

SPEAKER_01:

Okay, and what types of tests are there that are available now?

SPEAKER_00:

So all testing is done through blood testing, but there are what we call rapid testing. Uh, this is just a finger prick, usually in the office setting, that gives you a rapid result within a couple minutes on the possibility of HIV positivity or not. There are blood draws that are taken through a vein sample and sent off to a laboratory for testing, and those usually return within 24 to 48 hours. Um the both of these tests are very accurate. Sometimes when we do these testing, we do require secondary testing to confirm it. Um, but overall, when you group all the types of blood testing we can do for HIV, it's nearly 100%, I'd say 99.some percent accurate. Um, and so these are very um accurate testing and relatively quick to return um to know the results.

SPEAKER_01:

Okay, and if someone were to be diagnosed with HIV, what does treatment usually look like?

SPEAKER_00:

So this has changed tremendously over the last 20 to 30 years. Most people who are currently living with HIV and on treatment are getting oral medications. Um, it's sometimes that people are having to take a few pills either once or multiple times a day. There are regimens now where someone just takes one pill once a day. There are some people who get injection medicines less frequently, sometimes on monthly basis, up to every three months basis. So the amount of pills or frequency of treatment has decreased quite tremendously. Um, old HIV medicines that aren't used very frequently also had quite a few side effects and was a downside and a reason that a lot of patients maybe weren't as um compliant or uh perfect about taking their medicines as needed. Um, but now most of the side effects of the medicines are quite tolerable, if any, and patients usually are able to follow a regimen that is very effective in decreasing the amount of HIV that is in the blood samples.

SPEAKER_01:

Okay. Um and how effective are these medications in helping people live healthy full lives?

SPEAKER_00:

These are very effective medicines. Um, HIV, when it was initially discovered, was considered a death sentence because there wasn't effective treatment. But currently we have treatment that can decrease viral loads or the amount of virus in the blood to um levels that are considered what's considered undetectable. Um, the amount of virus is so small that uh our lab samples can't actually pick up that amount of virus. Um patients now living with HIV can live nearly um the amount of lifespan as someone who is not living with HIV. There is some small decrease in the um potential lifespan of people with HIV, but it really is getting closer and closer as we get new treatments to being similar to people who are living without HIV.

SPEAKER_01:

Oh, wow, that's amazing. Um, as a primary care provider, how do you approach conversations about HIV prevention, testing, or treatments with your patients?

SPEAKER_00:

So I really bring it up with all of my patients. Um, I think that if it's kept in this silo of only bringing up with people who are willing to discuss maybe their sexual practices or history of drug use or concerns for HIV, you're missing a large amount of people who could benefit from HIV testing. Um, as that's statistic, I said earlier, one in seven people that have HIV are needed or aware. Um, and oftentimes patients are fearful or embarrassed to talk about potential risk factors that could put them at risk for acquiring HIV. It's best as a provider that to just bring it up with patients and make it seem like it's a normal thing that we do and test for every single day, which it is, makes people feel more at ease. And if we diagnose the disease, then you can get on treatment quicker, you decrease your risk of transmitting it to other people. Um, HIV has definitely become more of an ability for primary care providers to treat effectively, whereas in previous years it was more in HIV specialty clinics, but the simplicity of medicines we use makes it much more accessible for primary care doctors.

SPEAKER_01:

Okay, wow. Well, thank you so much for sharing your insight with us today. Um, is there anything, any final words you might have to say?

SPEAKER_00:

I think I would just encourage everybody, even if you have low or no concern for HIV, bringing up the possibility of getting testing through a provider. It always helps to be as knowledgeable about your health as possible. Um there have been unexpected cases of patients being positive without them expecting it. There are very effective treatments now that can help not only your long-term health, but also your health of loved ones that are potentially at risk for HIV acquisition. So just bring it up to your provider and get more people tested.

SPEAKER_01:

Thank you for tuning in to the Medlake Health Connections podcast. We hope you found today's episode informative and inspiring. If you enjoyed the show, please subscribe, rate, and leave a review on your favorite podcast platform. Remember, the information shared in this podcast is for educational purposes only and should not replace professional medical advice. Always consult with your healthcare provider for any medical concerns. Stay connected with us on social media and visit our website at medlinkga.org for more resources and updates. Until next time, stay healthy and take care.