Ask Us Anything About… HIV/AIDS

Description – The video begins inside a Penn State College of Medicine conference room. Two individuals are standing in front of a screen that reads Health and Wellness with a focus on HIV. From left to right is, Scott Gilbert and Dr. John Zurlo.

Scott Gilbert  – From Penn State Health, this is Ask Us Anything about HIV and AIDS. I’m Scott Gilbert. You know, HIV was once regarded as a death sentence. There still is no cure; however, people who get HIV today are living long, happy lives. That’s one of the many things that’s different about HIV from, say, 30 plus years ago, when the disease was first entered into the public forum. Here, today, to talk about the current state of HIV and AIDS, and to answer your questions about it, is Dr. John Zurlo. He’s an infectious disease physician, and head of the HIV/AIDS program here, at the Milton S. Hershey Medical Center. Good to have you here with us today. Let’s start by talking about the terms HIV and AIDS. I feel like a lot of people use those interchangeably. Can you kind of explain, briefly, what each means, so we know that at the onset?

Dr. John Zurlo – Yeah. Sure. HIV is the virus that, of course, was discovered in the 1980s that, when it infects people, it can cause a kind of an immunodeficiency. The immunodeficiency is AIDS. That is to say it’s acquired immunodeficiency syndrome. So, once the virus causes damage to the immune system, such that it is – becomes so damaged that it can’t protect people who are infected from these unusual infections and cancers, and then we call it AIDS.

Scott Gilbert  – I’m thinking back to the 1980s, names like Liberace, Rock Hudson — the very first celebrities who came out and admitted that they had HIV or AIDS. And, what was the understanding of the disease back then? When scientists and physicians first started putting those puzzle pieces together, what did we know at the very beginning?

Dr. John Zurlo – At the beginning, it seemed to — the virus, the syndrome of AIDS seemed to attack certain individuals. So, for example, gay men, injection drug users, and at the time, way back when, it seemed like the people from Haiti were also involved. And so, at that time, we had some concern that there was an immunodeficiency that was something that was acquired. In other words, these people weren’t born with it, but they somehow acquired it. And, it soon became apparent in the early to mid ’80s that it was caused by a virus — something that spread from person to person. And that’s when we discovered that HIV was actually the cause of this immunodeficiency syndrome.

Scott Gilbert  – Today, what do we know about who’s most at risk? Have the demographics changed or shifted?

Dr. John Zurlo – Well, I mentioned Haitians. We don’t think about Haitians being uniquely involved anymore. But, clearly, it involves people who get it by sex, typically gay men. Also, women who are sexually active with somebody who’s been HIV infected. And, as we’ve seen now with the opiate epidemic, we’re seeing more and more people who’ve become infected by injecting drugs. So, those are the groups that are primarily involved.

Scott Gilbert  – In 2015, I believe, I read about two-thirds of all diagnoses were gained by sexual men, correct?

Dr. John Zurlo – Yeah, that’s probably correct. Yeah.

Scott Gilbert  – And, according to the US Department of Health and Human Services, more than 1.1 million people today are living with HIV. Here’s the shocking part, though. Many people don’t realize it. How’s that possible?

Dr. John Zurlo – Well, you know, we talk about what’s called the HIV care continuum now. We try and understand where people are on the spectrum of, okay, so you’re infected, but you don’t know about it. Happily, we’ve made some ground there. Roughly 90% of people who are infected, in fact, know about their infection. But, then we have a steep drop-off into those who — let’s say you’ve learned you’re HIV positive, but have you connected with medical care? And, we know that there’s a large percentage – perhaps 40 or 50 percent of people, who have been diagnosed, but they’re not seeking medical care. Once you get into medical care — once you get on medication, then nothing but good things happen — when people get on medication and the virus comes under control.

Scott Gilbert  – You’re watching Ask Us Anything About HIV and AIDS from Penn State Health. I’m Scott Gilbert, alongside Dr. John Zurlo. And, we welcome your questions for him about this important topic, whether it’s live on this Facebook video, here, on Wednesday, or if you — or Tuesday, today’s Tuesday, right? Or, if you’re watching it on playback, you can feel free to add your questions to the comment field below this Facebook post. And, we’ll make sure we get an answer for you from Dr. Zurlo. You know, HIV, as we mentioned at the top, was once regarded as a death sentence. Now, it’s viewed more so as a chronic illness. Can you talk about some of the medical advances that have caused this shift and made this possible?

Dr. John Zurlo – Yeah, yeah. Through my career, in the ’80s and early ’90s, we watched people get this virus. Their immune systems became very weakened. And, they died of all these complications. And, we know that, without treatment, we think at least 95% of people who are infected with HIV, would otherwise, eventually die of these horrible things. Beginning, really, in the mid ’90s, we finally developed effective anti-viral treatments to really fully control the virus. And, those treatments really have sort of been modified and advanced to the point now, there are many of these regimens of medicines that are combined into one pill. And, really, it turns out to be just one pill per day, usually extremely well tolerated people – tolerate them very well. Which completely shuts off the virus, and keeps it from causing damage to the immune system. In fact, when we see that the virus is controlled like this, the immune system has a lot of ability to heal itself, and patients do extremely well. And so, in fact, when I talked with my patients, I don’t say that they have a chronic disease. Disease would imply that there’s something continuing to go wrong with them. But, in reality, once they’re on treatment, they’re virus is fully controlled, I could say that have a chronic infection. But, it’s not really causing any damage, because we know that people with HIV who are on these medicines fully controlled, can live a virtually normal, healthy life.

Scott Gilbert  – It’s being contained. It’s in them, but it’s still — it’s being contained and not holding them back.

Dr. John Zurlo – Yeah, that’s correct. Unfortunately, we haven’t reached the step where we can actually cure it. That’s one of the challenges. We know that when people are infected, though we can fully control it, there’s still some virus that sits in these long-lived types of white blood cells in our body. And, somehow, the medicines aren’t affective in eliminating all of those — what we call viral reservoirs. So, unfortunately, at least to our thinking now in 2017, when people stop medication, unfortunately the virus is still there, and it can rev itself back up, and continue to cause trouble.

Scott Gilbert  – But, is the fact that this condition treatable now, through medication, has that had a negative effect, in terms of the fear of the disease? I mean — you remember that the perception of AIDS and HIV in the ’80s and even early ’90s. Has that changed? Are people less fearsome of it, and therefore, perhaps less aware of avoiding behaviors that can cause it?

Dr. John Zurlo – Yeah. Unfortunately. That’s the downside of it. We’ve seen now, though the numbers of cases of people with HIV being diagnosed have come down, we see, now — this is very promising over the last few years. But, we also, at the same time, see that people who are not as afraid of it, who are engaging in behaviors, typically sexual behaviors, with partners that they don’t know who could be infected, often without condoms, and unfortunately becoming infected. Not just with HIV, but we’re seeing an upsurge in certain kinds of sexually transmitted diseases. So, we here, and nationwide, have seen just this huge upsurge of syphilis cases. And, it’s almost all in men. And so, that’s a challenge. Our — particularly our gay men, engaging in lots of sexual activity with a lot of different partners are becoming infected, still, with HIV and all these other sexually transmitted diseases.

Scott Gilbert  – Are there misconceptions out there about how HIV spreads? People fearing that it spreads this way or that, when that’s not really the case.

Dr. John Zurlo – You know, I think that the public is generally pretty understanding of how HIV is spread. I do think there’s a general understanding that it can — that it’s mostly spread sexually. I think it’s a matter of people just not understanding that, indeed, when they are sexually active with somebody, they don’t know their status — their HIV status. Their just — they underestimate the possibility that that person could be infected.

Scott Gilbert  – And therefore infect them. You’re watching Ask Us Anything About HIV and AID from Penn State Health. This is Dr. John Zurlo. He’s an infectious disease physician. He also heads the HIV/AIDS program, here at the Milton S. Hershey Medical Center. Dr. Zurlo welcomes your questions in the comment field, whether you’re watching this video live or on playback. What kind of role do healthy behaviors — I’m thinking of things like exercise, diet, and mental health, play in the overall health picture for somebody who has HIV or AIDS?

Dr. John Zurlo – You know, that — we think it plays an enormous role. So, we have somebody who’s HIV positive. They come in. They get tested. They get on treatment. And, they’re under control. Well, all of that is great. But, we know that for people who are HIV positive, it — even when it’s fully controlled, it may add some additional risk, for example, for cardiovascular disease — to develop, for example, strokes or heart attacks. And so, as it turns out, we understand both in our population that we care for, here and nationally, a lot of the patients that we deal with, that we treat — they are smokers, for example. And, we know that the combination of the slightly increased risk of heart, disease because of HIV, and smoking is a bad combination. So, that’s one of our many things that we try and focus on — getting people to stop smoking. You know, now that you’re HIV positive, it doesn’t mean you can’t gain weight, like lots of other people. So, we deal with things like obesity. We deal with high cholesterol. So, all of these things, we try and bring together and create a comprehensive treatment plan for people. And then, the final step is, get them into a good exercise program. Stay fit. There’s no reason that anybody with HIV positive — who is HIV positive shouldn’t and couldn’t get involved in the same kinds of exercise programs that everybody should be doing.

Scott Gilbert  – So, it goes beyond just taking that one pill each day. A healthy lifestyle, which frankly we should all be doing.

Dr. John Zurlo – A healthy lifestyle. And, it’s really part of both our plan, and I think anybody who’s involved in HIV care, now, of their patients — they’re going to want a comprehensive treatment plan. Not just take your HIV medicine, but a whole comprehensive care plan to stay healthy.

Scott Gilbert  – If someone watching this video believes that they may have been exposed to HIV, what steps should they take? What should they do?

Dr. John Zurlo – First and foremost, get tested. There’s testing sites throughout Pennsylvania, throughout the commonwealth. It’s very easy to check with the Department of Health website, or websites at Hershey Medical Center through our OPT-in site. And, you can find places to get free, confidential HIV testing. The test is highly accurate. Again, free. Anybody can afford free. And, that’s the best thing to do, is to get tested.

Scott Gilbert  – Now, Dr. Zurlo just made a reference to OptInForLife.org. That’s OptInForLife.org. That’s an important website. Behind that is a very important collaboration. I’d like to talk with you a bit about that. It’s a grant-funded collaboration that serves as a resource for people who are affected by, and infected with, HIV. Can you talk about the two-fold goal of OPT-in for life?

Dr. John Zurlo – Yeah. OPT-in for life is our own brand that we’ve created. It means opportunities for prevention and treatment. So, OPT-in. It’s a positive message that we want people to find out about their HIV, get tested, get in care, and get under control. We know that — behind the OPT-in project is a couple important facts. The OPT-in project is aimed, really, at youth and young adults. Because we know that, on the one hand, youth and young adults are — who are infected, are least likely to know that they’re infected or to be in care, and therefore, not to be on treatment. We also know that the same population of youth and young adults are very tied to social media. They’re tied to their phones, to their apps, to social media sites — Facebook, Twitter, and everything else. So, with funding through the — through HRSA — through the Ryan White program, which funds HIV care throughout the nation, we’ve received this funding. And, it’s a collaborative program that we’ve created with Penn State Hershey, and Pinnacle Health, Alder Health Services in Harrisburg, and Hamilton Health. We’re all part of this collaborative, where we are focusing on our populations in the greater Harrisburg area, of youth and young adults, who are HIV positive. We want to bring them into care. And, those that are in care, we want them to join our research program, where they can download an app that we’ve created, that will give them abilities to communicate with us, their care providers. To be able to look at their lab and results of testing to know that they’re under control. They can set reminders for their medications. All of these things. And, we think it’s — so far, it’s been very successful in bringing youth and young adults into care in the greater Harrisburg area.

Scott Gilbert  – Is it — it sounds like a big part of it must be to reach people who’ve engaged in some of these behaviors that could lead to HIV and may not realize that they may be carrying it.

Dr. John Zurlo – Yeah. Absolutely. And, it is youth and young adults, of course, who are most sexually active of any age group — no surprise. And, therefore, they have a high risk of being infected. And therefore, also infecting other people.

Scott Gilbert  – And, keeping these people engaged is so important, because I find it kind of surprising that as easy as it is to manage this illness — or this virus, I should say, to be more correct about it — there’re so many people who, as you mentioned, just kind of fall out of their treatment regimen. And, that can’t have a good affect.

Dr. John Zurlo – Yeah. I think one of the challenges is — I think for many, HIV is sort of — they know about it. But, you know, out of sight, they don’t think about it very much. And, I think that one of the other challenges — you think about medications for other kinds of illnesses; they take a medication, and they feel better with it. Well, for many of our patients who have never been sick because of HIV, whether they take their medicine or not, whether they go to their visits or not, they feel the same. Remember, HIV — the disease really plays out over months and years. So, day-to-day, they don’t feel different, whether they take or don’t take their medication. But, the key is making them understand that in order to really have full control of this virus, and stay healthy, and never get sick from it, they have to take this medication. One pill every day. As I say to my patients every day, you know, it will take about 15 seconds to take that pill, swallow it down — the rest of the day is yours. But every day, you got to take that medication to stay healthy.

Scott Gilbert  – The website is OptInForLife.org. And, tell me about some of the examples of community outreach that are happening. It sounds like, as you mentioned, because of audience being young adults, teens — a lot of that is through the social media and through electronic means. But, you know, what are some of those efforts that this involves to bring those people together for this important dialogue?

Dr. John Zurlo – Well, once again, the major focus is social media. But, we’re out there. We’re out in the streets. That’s what we’ve hired and collaborated with the Alder Health Services in Harrisburg. It’s a clinic and program that serves, among others, the LGBT community in the Greater Harrisburg area. We have Hamilton Health who is very involved in the infected and highly affected communities, within Central Harrisburg. They’re out. We have outreach workers who are sort of traveling around the schools and the venues, where they might people, to try and, in a sense, sell the brand. The brand being OPT-in. And, once they get sold into the brand, maybe they’ll get tested. Maybe they’ll get into care. And, maybe they’ll, therefore, come under control and do well.

Scott Gilbert  – It’s a good mission. Good luck with it, and thanks a lot for your time today. Appreciate it.

Dr. John Zurlo – Alright. Thank you very much for having me.

Scott Gilbert  – Alright. Dr. John Zurlo. He’s an infectious disease physician. Also head of the HIV/AID program, here at Penn State Health Milton S. Hershey Medical Center. One last time, that website to check out is OptInForLife.org. That’s OPT-in for Life — all one word — .org. And, we’ll put a link to it, as well, in the comments below this Facebook post. Whether you’re watching this live or on playback, we welcome your questions for Dr. Zurlo. And, we’ll track down some answers for you about HIV and AIDs. Thanks so much for watching Ask Us Anything About HIV and AIDS from Penn State Health.