Since the discovery of first medication to treat HIV in 1989, we have come a long way in understanding the disease and changing its course. The current treatment for HIV is called antiretroviral therapy (ART). It is often one pill to take daily; moreover, we now have injectable treatments as ART given once a month, and soon every 2 months or even at longer intervals in the near future.
The rationale for treatment is twofold: live longer and healthier, and prevent transmission.
HIV attacks and destroys the infection-fighting CD4 cells (also known as T-cells) and these are part of the immune system. Loss of CD4 cells makes it hard for the body to fight off infections and certain HIV-related cancers.
HIV medicines prevent HIV from multiplying (making copies of itself), which reduces the amount of HIV in the body (called the viral load). Having less HIV in the body gives the immune system a chance to recover and produce more CD4 cells. Even though there is still some HIV in the body, the immune system is strong enough to fight off infections and certain HIV-related cancers.
By reducing the amount of HIV in the body, HIV medicines also reduce the risk of HIV transmission. A main goal of HIV treatment is to reduce a person’s viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test. People with HIV who maintain an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative partners through sex.
Since 1989, physicians at CVM have been involved in clinical trials to find new medications, increase treatment options, while providing more effectiveness and less side effects.
The choice of an HIV treatment regimen depends on a person's individual needs. We at CVM choose the medication with you, not for you, and while considering many factors, including possible side effects and potential drug interactions, as well personal circumstances and needs. On your first visit to CVM, we will start treatment, if you are not being treated already, or evaluate your current treatment, not only from point of effectiveness but also discuss other options that might be more tolerable and better suited.
PrEP, or pre-exposure prophylaxis, is an HIV prevention method in which people who don’t have HIV take HIV medicine to reduce their risk of getting HIV if they are exposed to the virus.
PrEP is highly effective when taken as indicated. The once-daily pill reduces the risk of getting HIV from sex by more than 90%. Among people who inject drugs, it reduces the risk by more than 70%.
PrEP may benefit you if you are having a sexual partner with HIV (especially if the partner has an unknown or detectable viral load), or have not consistently used a condom, or have been diagnosed with a sexually transmitted infections (STI) in the past 6 months.
Currently, there are two pills approved for daily use as PrEP They are combinations of two anti-HIV drugs in a single pill: Emtricitabine 200 mg in combination with tenofovir disoproxil fumarate (TDF) 300 mg (brand name Truvada. A generic version of Truvada® is also available), and Emtricitabine (F) 200 mg in combination with tenofovir alafenamide (TAF) 25 mg (brand name Descovy®); the medications in Descovy are the same as those in Truvada, with one of the medications (tenofovir) is in a new formulation.
PrEP is safe. No significant health effects have been seen in people who are HIV-negative and have taken PrEP for up to 5 years. We at CVM, monitor our patients regularly for potentially side effects as well as the general health.
Newer ways to prevent HIV infection are on the horizon (longer acting pills, injectables, implants, etc.).
And be aware: PrEP protects against HIV but not against other sexually transmitted infections (STIs) or other types of infections. Combining PrEP with condoms will reduce your risk of getting other STIs.
Post Exposure Prophylaxis
PEP stands for post-exposure prophylaxis. The word “prophylaxis” means to prevent or control the spread of an infection or disease. PEP means taking HIV medicines within 72 hours (3 days) after a possible exposure to HIV to prevent HIV infection. PEP should be used only in emergency situations. It is not meant for regular use by people who may be exposed to HIV frequently. PEP is not intended to replace regular use of other HIV prevention methods, such as consistent use of condoms during sex or pre-exposure prophylaxis (PrEP). PrEP is different than PEP, in that people at risk for HIV take a specific HIV medicine daily to prevent getting HIV.
PEP may be prescribed for people who are HIV negative or do not know their HIV status, and who in the last 72 hours:
May have been exposed to HIV during sex, or
Shared needles or other equipment (works) to inject drugs, or
Were sexually assaulted, or
May have been exposed to HIV at work
The sooner PEP is started after a possible HIV exposure, the better. According to research, PEP will most likely not prevent HIV infection if it is started more than 72 hours after a person is exposed to HIV.
If you are prescribed PEP, you will need to take the HIV medicines every day for 28 days.
We at CVM, prescribe and monitor PEP, for efficacy and potential side effects.
The crucial thing to remember: start PEP immediately after a known or potential HIV exposure.
Patients at Chelsea Village Medical receive their primary care at our office. Primary care at CVM is characterized by being accessible, comprehensive, coordinated, continuous, and accountable.
As a patient at CVM, you will have access to us at all times, to receive comprehensive care, not just HIV treatment and prevention. We will coordinate your care through other specialists, and help you get the treatment that you need.
Although our main focus is on Men’s Health in general, and HIV infection, we also focus on entire health needs and within these parameters, we provide include routine and specialized laboratory testing and physical examination, preventive care through screening for cancer, heart disease and vaccinations.
Along with medical history and gathering useful information, physical examination is the process of evaluating objective anatomic findings through the use of observation, palpation (feeling with the fingers or hands during a physical examination ), percussion (method of tapping body parts with fingers, hands, or small instruments), and auscultation(listening to sounds from the heart, lungs, or other organs, typically with a stethoscope) .The physical examination, thoughtfully performed, should yield 20% of the data necessary for patient diagnosis and management.
The annual physical examination includes diagnostic testing (EKG, X-ray for example), screening for cancer (rectal cancer, prostate cancer and others) along with review of immunity status and vaccinations. Every patient at CVM receives an annual exam.
On a routine visit, the exam is focused on the reason for the visit, as well as general examination.
We at CVM believe that physical examination is an adjunct to a thorough history and as a way for the physician to interact physically with the patient, hence, visits at CVM are 45 minutes appointments for routine visit, 90 minutes for annual visits and 120 minutes for new patient visits.
Lab Tests and Screenings
Laboratory testing has an acknowledged widespread role in clinical decision making, and therefore a role in determining clinical outcome. In treating HIV infection and its complications for example, we rely on laboratory testing to help guide our treatment, monitor the benefits and detect side effects. We particularly use two main tests, T-cell subset and plasma virus load in making treatment choices; however, with prolonged treatment, complications can be seen and laboratory testing provide useful tool.
Given the importance of T-cell values, we decided to perform this test in our laboratory; this becomes of increased consequence when we compared our results to those from two outside commercial laboratory service, where they report calculated values for T-cells; we measure them in our laboratory. This is time consuming and costly, but produces reliable results we use in making clinical decisions. We also measure other aspects of the immune system when checking for T-cell count, commercial laboratories do not.
We also measure hormones that are affected by HIV infection, such as testosterone ( as well as female hormones in male, prostate specific antigen (PSA) affected by testosterone ), human growth hormone ( for its role in lipodystrophy, a potential complication of HIV infections and the medications used to treat it), insulin ( its role in lipodystrophy as well as diabetes), among other markers for heart and kidney diseases.