Augusta, Ga. When Dr. Cheryl Newman meets an HIV-positive patient, one of her first questions is whether he knows anyone else with the infection.
The usual response is about dead relatives or friends. "We talk about what that experience was and how, in all likelihood, his experience will be very different," said the infectious-disease specialist at the Medical College of Georgia at Georgia Health Sciences University. "Yes it's the same virus and could have the same outcome if patients do not take advantage of treatment, but in no way does it need to be the same."
Newman, who finished her training about the same time HIV infection began consuming her specialty, also has too many memories of lives lost to HIV. But two-plus decades later, most patients can live long and well taking a single pill daily.
A $3.4 million, three-year grant from the U.S. Department of Health and Human Services for Georgia Health Sciences University will help maintain the new normal. Funds ensure that uninsured patients in the Augusta area get medication and other needed treatment and that the Ryan White Outreach Team continues to reach into the community with rapid testing, education and treatment referrals. GHSU has been funded since 1995 through the Ryan White Comprehensive AIDS Resources Emergency Act to provide these services in 13 nearby Georgia counties as well as Aiken and Edgefield counties in South Carolina.
"We have gotten considerably better at treating the disease," said Dr. J. Peter Rissing, Chief of the MCG Section of Infectious Diseases and the grant's Principal Investigator. "In better than 60 percent of our patients, their virus is undetectable, their immune system is on the rebound, they don't have opportunistic infections. They come see us every six months and we make sure their virus remains undetectable and that their immune system is continuing to mend."
Still, in what Rissing describes as "a dance between the immune system and the virulence of the organism," the best partners are the Ryan White program that enables access, patients who take the improved medicines as prescribed and persistent, hitting-the-streets efforts to get people screened.
Today's drug therapies keep the virus at bay by attacking it from different directions to prevent it from multiplying, Rissing said. Most otherwise healthy patients require only a single pill that combines two or three of these drugs; more rigorous regimens are needed if symptoms such as severe diarrhea and weight loss suggest the virus has damaged the immune system, Rissing said. The virus can become similarly active if medicine isn't taken as prescribed, he noted.
Newman is currently studying a once-a-day pill that prevents the virus from inserting itself into the DNA of cells in the body where it can live and eventually multiply. "We say it takes three active drugs to knock out the virus," she said, optimistic that the drug she is studying will one day enhance the efficacy of one of the two-drug therapies on the market. MCG has participated in the clinical trials of most HIV drugs already in use.
Georgia Health Sciences Health System treats nearly 1,300 HIV-positive patients, most of whom are males age 45-64. The biggest patient increases in the past decade are at both ends of the spectrum. People younger than 23 are among the largest number of newly infected and the older population is increasing because patients are living much longer, said Larry Howell, Grant Manager.
Dorothy Stokes, a patient advocate, works with drug manufacturers and the state to ensure proper medication for uninsured or low-income patients. The state-run AIDS Drug Assistance Program is extremely helpful although new patients face a waiting list. Drug manufacturers are helpful as well, Stokes said.
The Ryan White Outreach Team frequents popular gathering places, including ice cream parlors, nightclubs and, starting within the last six months, various area Walgreens.
The pharmacy chain is proving to be another good partner in outreach, which remains vital since an estimated 25 percent of infected individuals are unaware of their status, Howell said. But experience has shown that when status is known and virus levels are kept low, so are transmission risks, Rissing said.
The 17-year continuum of testing and care has yielded additional benefits, including a cohort of patients large enough to enable the clinical trials that make the latest therapies available to area patients. The GHSU/Charlie Norwood Veterans Affairs Medical Center Psychology Residency Program is one of 23 programs in the U.S. and Canada to offer specialized HIV training as well as one of a handful to offer a yearlong experience that leads to a specialty in medical psychology with an HIV emphasis. Ryan White funds also help support a GHSU College of Dental Medicine residency program that provides dental care to HIV patients.
|Contact: Toni Baker|
Georgia Health Sciences University