HIV Prevention and Treatment

HIV, or human immunodeficiency virus, is the virus responsible for HIV infection. This acronym can refer to either the virus itself or the infection it causes.

AIDS, which stands for acquired immunodeficiency syndrome, represents the most advanced stage of HIV infection. 

HIV specifically targets and destroys CD4 cells (CD4 T lymphocytes), which are crucial for a healthy immune system. The depletion of these cells hampers the body's ability to fend off infections, illnesses, and certain cancers.

Without treatment, HIV can progressively weaken the immune system, leading to a decline in health and potentially advancing to AIDS. This progression increases the risk of contracting other infections, such as hepatitis, tuberculosis, and some sexually transmitted infections.

However, with appropriate treatment, it is possible to prevent HIV from damaging CD4 cells, allowing the immune system to recover and maintain its defense against other infections. 

@Medical Class 901

Transcript

SPEAKER_00 0:04

Welcome to Medical Class 901 with Dr. Chi. I am Dr. Chinello Animallo, infectious disease and HIV specialist and a professor of medicine at UT College of Medicine here in Memphis. So this is a show where we discuss um different and various types of infectious diseases and infection. And in prior episodes, we've you know talked so much about HIV because this is something that is becoming so rampant in our country. So today our show is gonna focus mainly on prevention and we're gonna talk about PrEP and PEP. These are things that are very common in the HIV world. So um what we're gonna do right now is more like gonna be like a medical class. So please bring out your papers, bring us your pen, and let's get to class. Alright, so I'm gonna start uh with prevention of um HIV. Um, prior to going into that, the first thing I'm gonna do is kind of review the modalities of spread, like how do people get infected with HIV? This is something that we have um talked about several times on this show. So the commonest mode of transmission would be sexual, um, meaning any kind of sexual intercourse, be it vaginal, oral, or um, you know, anal sexual intercourse, any kind of um you know situation where there's a break in the barrier or the mucursor of the body, and there is some kind of exchange of body fluids between two people, that would be the commonest mode of transmission. Then, of course, there's something that's called the vertical transmission where a mom, a woman who uh knowingly or maybe knowingly knows she's HIV positive, does not get cured and um passes it down to her unborn baby. Another mode would be sharing of needles. Um, this could be perhaps you know, among the population of people with um they use IV drugs or even somebody that perhaps um takes insulin and you share your needles with other people, um, this would be another common mode of transmission. So, in terms of prevention, we kind of will start by addressing these modes of transmission one by one. So, let me start by you know, being a woman myself, um the phomaternal transmission or the vertical transmission, and this is where a pregnant woman transmits the virus to her baby because she had untreated HIV. And so, where where can you know one question would be like, you know, how is this possible? And so, for instance, a woman who did not receive care, you know, a prenatal care when she was pregnant, um, you know, did not know she has HIV, could easily pass it down to her unborn baby. So we do encourage women, um, whether you're insured or uninsured, to please, you know, go to the nearest clinic, um, you know, plug yourself in with a doctor. There's so many facilities here that would take care of you for the fact that you are pregnant. And part of the walk up or the test that is done would be to check you for HIV. And if for some reason that happens to be positive, then um the normal thing would be to put you on HIV medications to prevent you passing this infection onto your unborn baby. Then another thing would be to encourage people to not share needles. So, you know, regardless of you know, if you're an Ivy drug user or any other kind of situation, maybe you take you know shots for diabetes, you know, insulin or whatever other reason, please do not share your needles. Blood transfusion, you know, could be a mode of transmission in uh maybe some you know developing countries, but this is not something that you're gonna see here because the blood that we use here is well screened for HIV and other infections, such as hepatitis B, hepatitis C. So it's gonna be very um unusual to have this kind of spread. Another uncommon one would be spread amongst healthcare workers. And so we call it like accidental splash. It could be a doctor who is operating and you know accidentally cuts himself, or there's a splash of bodily fluid on the you know, doctors and nurses, or a nurse is trying to draw blood from a patient accidentally sticks herself if the patient is HIV positive. So these are you know the commonest uh modalities of transmission. So what we're gonna do now would be to talk about prevention. So, how do we protect ourselves? How do we prevent transmission of HIV? So this would take us, you know, to we call it PrEP, right? Prophylaxis. So I'm sure you know most people who are familiar with this infection would have heard about PrEP. PrEP stands for pre-exposure prophylaxis. Okay, what is prophylaxis? This sounds like some big name. Prophylaxis is just a medical term for, would I say things like prevention or mode of you know stopping spread, you know, like when you anticipate that um you could get you know an infection and we give you something to prevent that. So that's basically what the word prophylaxis stands for. It's just a medical term for um basically prevention. All right, so PrEP, as we talked about, pre-exposure prophylaxis is basically what measures, what you do to prevent yourself from getting HIV if you fall into a high-risk population. So before I delve into that, let's talk about high-risk population. What would what are we going to consider a high risk? So, one would be, for instance, if you are sexually active with someone or people that you do not know their HIV status, basically unknown HIV status. So this individual you are involved with, you know, are the HIV positive or negative, you don't know. So that will fall under high risk. Another population would be if, for instance, you have multiple sexual partners. So, you know, maybe every weekend there's somebody new or some, you know, something, but that also puts you under um high risk. And again, if you are in a situation where you have to reuse needles or share noodles, and these are things that will put you in high risk. Sexual workers, um, you know, people that um have sex for money or for you know, in exchange for for other things, could also fall under this category. So, and these are people that um prep is available for, it's available for for me, it's available for you and for everybody else. So, let's talk about that. Um, oh, something I would really wanted to talk about again would be you know abstinence. So, for some people, abstinence might be an option. What does this mean? Um, if you're not sexually active or you kind of want to keep yourself till you're ready, um then that would be something to consider. So we are gonna take a very quick break and then when we come back, we'll delve into prep and pet. Thank you. Thank you for tuning in to Medical Class 901, a show where we discuss the common infections we see in our communities. I am Dr. Cinello, Animal Infectious Disease and HIV Specialist. So remember to tune in to Xfinity channels 17 and 1091 on Mondays at 7:30 p.m. So see you then. Welcome back to Medical Class 901 with Dr. Chi. I am Dr. Cinello, Animal Infectious Disease and HIV specialist. And on this episode, we are talking about prevention of HIV. And so, just a quick recap we talked about the modes of transmission, what we consider to be their high-risk population, and the indications for PrEP. And so that's kind of where we are right now. So, I'm gonna talk a little bit more about PrEP because I'm sure you've seen the adverse on TV, you know, from different pharmaceutical companies talking about PrEP and PEP. So uh we already talked about PrEP. This stands for pre-exposure prophylaxis, these are medications that we give in patients or people who are considered high risk for contracting um HIV due to either um sexual practices or what we call you know behavioral you know modalities or due to epidemiology. For instance, uh those people that live in places like Memphis, like myself, Houston, Miami, these are places that have you know significant cases of HIV. So you kind of you want to be safe. All right, so how okay, so the question would be okay, you keep talking about prep, Dr. Chi. How do I get this? Or you know, how how do I, you know, obtain this? Do I have to go to a doctor? Absolutely. So um there are doctors around the town, you have infectious disease doctors such as myself and other doctors, some primary care doctors whom um you can go to. You also have some places like Friends for All. You have some nonprofit organizations that participate in HIV care. And so um PrEP gives you about 99% protection from contracting HIV amongst people in this high-risk population if you take it according to your doctor's prescription. Okay, so I will talk about that a little bit. So um, so who can get PrEP? Anyone can get PrEP. Anyone that feels that they need it, that they are they fall into this high risk category, or you know, or kind of anticipate that they might be in the high risk category, then you also can get prep. All right. So um, what are the indications that we talked about? Um, you know, not knowing you know, someone else's sexual status, somebody you're gonna be involved with. Um, so prep works when you take it in a timely manner. So let me give you a typical scenario. Let me just create a typical scenario. So we have a young lady who, you know, maybe was out in the club, you know, had some kind of sexual intercourse uh with a male, and not sure, you know, this is 24, 48 hours later, um, not sure, you know, if this person has HIV or not, you come to the doctor, what we're gonna do is to put you on medication to prevent you getting this virus. So, what these medications, these are all HIV medications that come in combinations, they're not like one single pill. So you have some of them are two pills in one, and I'm gonna um talk about those in a second. And what happens is that we give you this medication, what it does is to prevent that virus. If there's any virus, HIV virus in your body, what it does is to stop it from replicating, meaning from multiplying and you know, causing you to have that infection in the future. So there are various types of preps that are available. You have two categories you have the orals, which are the common medications. I'm sure everybody has heard about truvada and Descovy, and then you have the injectables, these are the ones that you um you get the injections. So I'll talk about them and separately. So before we start you on PrEP, there's the most the most important step is that we must make sure you are HIV negative. If you during that initial screening test is HIV positive, you cannot get PrEP. We now have to put you on full-blown treatments for HIV. So this is very, very important. So if you show up in the clinic or you go to your doctors, before we give you PrEP, we must test you for HIV. Now, if you're negative, then we will go ahead and put you on PrEP. So, like I said, you know, you have various types available. Um, so it will depend on your doctor based on your kidney function, your liver function, your blood levels, and other underlying medical um diseases or illnesses, you have to decide which of these options uh will be the best option for you. Then we do a lot of counseling, right? Because um, if you are, you know, I see a lot of people that are like, ah, I don't like to take medications, you know, and stuff like that. This is something you have to take every day. So we always talk about counseling the patient to make you understand, you know, the risk and benefits of taking prep. But in my own professional opinion, if you fall into this high risk category, I mean, it's it's a no-brainer. Like you would I would take the pill daily, you know, compared to risking, you know, getting this infection that is a lifelong um infection. So, and another thing that we would do at that preliminary visit would be to, in addition to HIV, we would check and see if there are other infections. So just like just like um HIV, things like hepatitis B, um, hepatitis C are viruses that you will contract exactly the same way you would contract HIV. So we will also check you for things like that. We will check you for other STIs as sexually transmitted infections, such as gonorrhea chlamydia. And, you know, if there's any of this present, we'll go ahead and treat you in addition to providing you with a prep. So let's talk about the oral, um, the oral medications for that. Truvada, like if I have to take a poll, I'm sure everybody has seen that advert, you know, on the TV, you know, they talk about Truvada, which is part of what you're gonna see with Big Tavi. Um, you know, you're gonna see so many, you know, adverts on TV on these drugs talking about PrEP. So Truvada will be the commonest one together with Descovi. All right. And so these are pills. They're actually two pills in one. Um, so for instance, the um truvada contains two medications. We call it TDAF and FTC, which basically just means tenophovir, antisoperal, and um entries. These are the two medications that you have in truvada. And then you have Descovi, which also contains a tenophobir medication as well as entabin. I'm not trying to confuse you guys with all these medications, um, that's not important. Just know that these are medications that contain two active HIV medications in one pill. So it makes it so easy. So instead of having to take several pills, you're just taking one pill a day. So for someone that's had um, you know, maybe anticipate they're gonna be, you know, uh maybe find themselves in a situation where they might have unprotected sexual intercourse, you want to start this medication prior to that event. But let's say, again, like the young lady example I gave, you know, you find yourself in that situation, it's occurred already. What do you do? If you take PrEP within 72 hours from that index episode, the chances of you contracting HIV is almost nil. Okay. The the earliest you take it, the better it works. But usually it needs to be taken within 72 hours. If you take it after 72 hours, I don't know, you know, it could be 50-50, you know, um percent kind of thing. So you want to take it as early as possible. For those who are perhaps gonna, you know, in a relationship with somebody that you know has HIV but it's not well controlled, then you want to start PrEP as soon as possible. Again, this is medications that are taken daily, so you want to take it every single day, and you know, as long as the risk factor is there. Now, something I would like to you know mention as we're talking about this is um I'm sure you guys would have heard from maybe CDC where they said undetectable is equals to untransmissibility. And um, and what that means basically is that if you have someone who has HIV but is well controlled and has undetectable viral levels, meaning that the number of viruses in the blood is so low that it's not showing up in the test, then you don't necessarily have to be on prep, you don't need to take precautions as long as that person is well controlled. This is very, very important because I don't want you to misquote me. If somebody, your sexual partner, is well controlled with undetectable viral levels, you do not need to be on prep. But if you're not sure or that person doesn't really take their medications, or you know, either way, then please make sure you get on prep. So then you have two other options um that are injectables. The commonest one will be um cabotigravire. Cabotigravire is an injection that you take twice um every other month. So every two months you come to the doctor's office and you get the shot. And so these are long-acting anti-umiral medications. These are all HIV medications again, but um, so it will work for maybe people that don't really like to take pills, but you have to come in um every two months to get your shot. And then um just about two, three months ago, there's a new medication that was just um approved by the FDA. Um, it's a new medication by Gilead. It's called Yes2Go. Um, well, that's the that's the company's name, but it's called uh Linacapavir. And this is a new um HIV medication for prep that was just approved about two months ago, and it's giving is one shot giving every six months. So I mean, um that's just incredible, right? So you don't have to have to take a pill every single day, uh you don't have to get your injections every two months. This is something that you can take um one shot every six months, but it's not everybody that um kind of qualifies for that. So we will take a quick break, and when we come back, then we will talk a little bit more about PrEP and then PEP, which is post-exposure prophylaxis. Thank you for tuning in to Medical Class 901, a show where we discuss the common infections we see in our communities. I am Dr. Cinello, Animalu Infectious Disease and HIV specialist. So remember to tune in to Xfinity channels 17 and 1091 on Mondays at 7:30 p.m. So see you then. Welcome back to medical class 901 with Dr. Chi. I am Dr. Cinello, Animal Infectious Disease and HIV specialist. And on this episode, we are talking about prevention of HIV, and um, we just talked about PrEP, what that means, the category of people or individuals who um would benefit from PrEP. So, just a quick recap um PrEP is something that we give uh we give to people who are high risk for contracting HIV. Um, and you know, these are medications, HIV active medications that um come in pill forms or injectables. The pill forms you take once daily, and then we have two injectables that you take. One of them is every two months injections, and then the other one is a newly approved medication, uh Ms. Call Yes2Go by Gilead Pharmaceuticals, where you get injections once every six months. So we are gonna talk about PEPS, all right? So PEP, remember, we talked said is pre-exposure, so they medicate basically in a situation prior to exposure to the infection. Now, what happens post-exposure, right? So let's talk about PEP. PEP stands for post-exposure prophylaxis. We again talked about what prophylaxis means, it's just a medical term or you know, big fancy word for prevention or you know, um transmission of infection. So that's what um prophylaxis stands for. So um PEP would be um medications that we that we give after a possible exposure to HIV. So the the commoner scenario might be you know someone that um you know you already had some you know sexual relationships with someone with unknown HIV status, and you don't know if they are HIV positive or negative, um, then we will put you on PEP. This again, these are HIV medications. Another scenario would be for healthcare workers such as myself and um you know, or Know other doctors who during surgery might have a splash where they come in contact with bodily fluids of a patient who perhaps you know maybe it's HIV positive, but we don't know what the HIV status is, or it could be a nurse who was trying to you know put in an um IV on a patient and then you know accidentally pricks herself. So any kind of scenario where you have um you know unanticipated exchange of bodily fluids, uh, you would qualify for PEP, which is the post-exposure um prophylaxis. And these are basically again classes of medications, they contain several um HIV medications in one pill, and then you might have one or two other um other regimens that will require you to take more than one pill, perhaps two pills. And what they do again would be to kind of prevent you from getting the infection. So, since I work in the healthcare setting, let me talk about, you know, perhaps um, you know, a doctor who accidentally during surgery was splashed with blood from a patient who is HIV positive, or we do not know what the status of that patient is. What would that doctor do? So, what that physician is gonna do would be, you know, to quickly give us a call, you know, hey, this is what happened. Um, you know, I came in contact with blood of a patient. We don't know the HIV status, or perhaps it's somebody that's HIV positive. And what we do would be to put him immediately on post-exposure prophylaxis with one of the various regimens or drugs that we have available for that. And so we will do basically do a baseline HIV test and then you know have that person take that medications for at least 28 days and then we retest and you know make sure there's no conversion from um normal status to to HIV status. The time of initiation of these medications is so important. So don't wait for one week later, you know, after thinking about it. So if you find yourself, you don't need to be a physician, I just use that as an example. You know, it could be, you know, so things happen. You went to the club, you ended up, you know, in bed with someone, and you don't know their HIV status. Please go to the nearest, you know, um, hospital, emergency room. You have organizations, you could Google that, you know, health center, you know, for those of us that live here in Memphis area, go to the Shelby County, go anywhere that's close to you and say, hey, this is what happened. I need to be put on medication to prevent me from getting this infection, and they would do that. So one of the you know questions that we tend to get a lot in the healthcare setting would be, hey doctor, you know, um, what happens if I don't have um insurance? So we know that these are costly medications if you have to pay for it out of pocket. But you know, thankfully, for those that are insured, uh the major insurance carriers here in the United States, they all cover for these medications. So hopefully that should not be a problem. Now, if for some reason you are uninsured or you know you don't know what your insurance status is, please go to your nearest health center. You could go to Shelby County. There are organizations around here in other cities, things like Friends for All. There are so many organizations that um support people living with HIV, and they have these medications they can make available to you. So for I'm not just talking about Memphis. So even if you live in a place like, for instance, Houston, where there is this infection is now rampant, just check, you know, the best thing will be to go to your nearest healthcare center and you know, let them know, and they will be able to plug you into their system or into another system, be able to um, you know, direct you to where you can get this medication, bearing in mind that time is of essence. You have to take this medication as soon as possible, preferably within 72 hours from the time this has occurred to the time where you take the first dose of the medication. Then something else I would like to stress on would be what we call in the medical field, we talk about non-compliance status and what that means, non-compliance basically means when you're not compliant with taking your medication as prescribed by your doctor. So when I say this is a pill or pills you have to take daily, preferably every 24 hours around the same time, um, that's when it works best. So let's say now that you actually have high risk for contracting this infection, you know, you take the first dose today, you take the second dose tomorrow, and then you're like, I don't feel like taking any more medications, and you decide for the next seven days, uh, I don't want to take any pills. My friend, the chances of you contracting this infection is now high, but you can't blame that on the medication. You have to take responsibility for your own part. So that's why we do that counseling and we, you know, talk about compliance. You have to take the medications to give the medications a chance to work for you. So, um, as a healthcare provider, what do we do for our patients who we put on either PrEP or PEP? We follow up with you in the office. Usually every three months, like I said earlier, we want to check your status, we want to make sure you are still HIV negative. Why is this important? Let's say that you skipped, you know, from your 28-day pill um regimen, you skip a week or two weeks, and then you know, we find out, oh, you're HIV positive. What are we going to do? Right? Then we will have to take you off prep and actually put you on real medications. So compliance in this period is very, very important. Be it if you're on PrEP or if you're on PEP, compliance with your medication is very important. So these are things that we will check upon when you come to the doctor's office. Then some of these medications, like every other thing we take, be it Tylenol, you know, ibuprofen, it doesn't matter, every medication comes with their own side effects. So your doctor would also check your kidney functions, um, you know, check your blood count and check other things for other STIs, other infections like hepatitis, and treat accordingly. Sometimes, depending on you know, other medical issues, let's say somebody you know has hypertension or diabetes, we you know pay close attention to your kidney function and you know to make sure that we are giving you the optimal care and not causing you any harm. So I hope um this is you know a very kind of quick breakdown of what the role of PrEP and PEP in HIV management. So I'm gonna encourage every single one of us there. Please be safe, know your status, get tested, get treated, and if you're positive for any reason, get plugged up for prep, for PEP, or for treatment. So thank you for joining our medical class 901 with Dr. Chi, and we will see you next time. Thank you. Thanks for watching the Medical Class 901 with Dr. Chi M D.