TRANSCENDING “WHAT IF” TO “WHAT NOW”

A Report from the International AIDS Society Meeting  I have attended just about every International AIDS conference since they began in the early 1980s. I have learned something and improved my skill set in some way from each and every one of them. Some of these conferences had more benefit than others. One of the most game changing conferences was in 1996 at Vancouver, British Columbia. That new information was the advent of HAART therapy, which allowed us to transcend the dark ages when we had little or nothing to offer HIV patients that had any durable effect. This year’s International AIDS Society’s conference in Rome, Italy goes down as being even more of a HIV game changer, specifically in the area of PREVENTION. There are now several scientifically accepted studies defining how HIV medications not only can successfully manage HIV infection, but also under the right circumstances prevent HIV transmission to an unaffected sexual partner—one study reports up to 92% effective.  Equally important was the additional powerful evidence presented describing the success of pre exposure treatment for the HIV negative individual by taking HIV medication preventively.  There were 7,482 participants from 142 countries attending this conference. There is some reasonable caution here.  “Treatment as Prevention (TasP)” still requires the change of behavior and that’s one of the more difficult parts. 100% success requires using a combination of preventive strategies. It’s not one size fits all anymore to simply say "use a condom." Several of my sincere patients readily admit they don’t always follow that advice, and many more I suspect don’t admit to that. This new strategy for prevention will require community involvement and buy-in for success. Individualized recommendations will need to be given by experienced professionals. Techniques to stop transmission may include, condoms, serosorting, male circumcision, test and treat all those positive,  more HIV testing, pre-exposure prophylaxis for those HIV negative, treating all HIV positive to undetection, post exposure treatment for those who are negative before 72 hours after exposure, topical agents, and adherence with taking your medication. Some of these were previously not considered to be acceptable, but used in combination are successful. What is necessary is to choose the appropriate techniques in the particular combination that is right for you. The individual choices are efficacious, however to be effective you have to make the correct multiple choices and use them. There has been significant progress in vaccinations to modify disease for those who are positive and to prevent disease for those who are negative. One vaccine study reported about 40% effectiveness. This is significantly better than previous studies and gives hope for a vaccine. Another vaccine study with favorable results is expected out sometime next year. There were also several presentations about HIV, inflammation, and pre-mature aging. Treatment as Prevention is also a strong reason, in addition to several others, to initiate therapy at a higher CD4 count.  I have already been suggesting this to many of my patients, however now will be making an even stronger case for doing this. Of course, we work as a team, and for those of you not ready, we will continue to reassess our medical plans with the latest information. In regards to starting therapy, we have some great investigational drug studies available for participation if interested. The next and probably most difficult obstacle is convincing our politicians and community leaders to spend the money in this terrible economy and listen to the scientists about earlier treatment and treatment as prevention. It will be very expensive; however, treating more people now will be very cost effective in the long run.  The pharmaceutical companies need to be involved in these efforts too. You know what they say: Rome wasn’t built in a day. Speaking of Rome, it is a very charming city. The venue for this conference was outside the city at a site where the Olympic Games once took place. The city itself was historic and well preserved. You can really learn from history, especially when visiting the Roman Collesum, Forum, and Vatican, which I barely had the time to do. Also, the Italian wine is yummy and cheap! That’s about the only thing that was. I have a lot of specific information from the conference I would like to share with you. I have scheduled one of our patient get together sessions for Thursday evening August 25 to do this. Also, it is not too early to consider attending the World AIDS Conference July 10-12, 2012 in Washington D.C.  This conference is a little different from the International AIDS Society’s conference. The World AIDS and IAS conferences alternate every other year. The World AIDS Conference has areas of interest for individuals with HIV and Community Activists in their Global Village.  I am planning to offer up some financial scholarships for my patients wanting to attend.  There will be more to follow as I develop a plan to do this. To Your Good health…I Remain Paul Benson, D.O.

Be Well Medical Center: 1964 W. 11 Mile Road  - Berkley, MI 48072 ph: 248-544-9300 - email: DrPaulBenson@DoctorBeWell.com