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CROI 2010 Wrap-Up: Complications of HIV and Its Treatment

A Discussion With Pablo Tebas, M.D.

March 30, 2010

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Summing Up: A New, More Holistic Era for the HIV/AIDS-Treating Clinician

Myles Helfand: Taking a step back: We just spent a good amount of time wading through a significant number of studies that talk about the long-term impact of HIV -- and maybe, to an extent, antiretroviral therapy -- on a range of different key complications: cardiovascular, inflammation, cancers, bone issues, CNS. All of this gets at something that you said a little bit earlier in our conversation about how the nature of what it means to be an HIV care provider seems to really be changing. These studies presented at CROI don't revolve so much around specific issues of which drug to take. It's becoming more about the management of all of the other things that a person might encounter as they live with, and deal with, the impact of HIV.

Pablo Tebas: I think you're absolutely right. If anything, this CROI meeting was about the complications of HIV and its treatment more than new antiretroviral drugs. There were no earth-shattering new antiretroviral treatments or paradigm shifts in the treatment of HIV. The general theme of this CROI meeting was about the complications of HIV: cardiovascular, cancer. There was even a session about H1N1, CNS, bone disease.

So, yes, the nature of being an HIV doctor is shifting. For a while, for a few years, we needed to know about all the antiretroviral medications, the resistance patterns. And we still need to know about all that. But now, it's becoming much more general internal medicine. You have to deal with all these things, and you have to learn how to manage them, and to be proactive in managing them.

Being a provider is going to be different in different states or even different payment environments. Sometimes HIV providers are also the primary care provider for the patient. If that's the case, they have to take full responsibility for monitoring for all these other issues. In some states, or in some markets, the HIV provider is a specialist, where the patient is just referred to them for HIV care.

What happens is that the patients usually see their HIV provider four or five times a year, and they might see their primary care provider only one time a year. It would really be a pity and a waste of opportunities if the HIV provider doesn't try to do some interventions to improve the overall health of their patients.

I think HIV providers are going to become more and more general internists in the care of HIV patients, which I think is a good development, because I like internal medicine, to tell you the truth.

Myles Helfand: This isn't a bit of a tall order to ask of practicing HIV physicians? Or ID [infectious disease] docs who take care of some HIV-infected patients, who suddenly need to take on knowledge and understanding of a wide range of other areas?

Pablo Tebas: Well, yeah. It may be a tall order. But I think it's the nature of the thing. And I think the HIV providers in general have been very adaptable and have adapted themselves to the changing circumstances of HIV care. And I think this is going to be the way of the next decade, until we find a cure for HIV. We're going to have to deal with all these other complications.

Hopefully this challenge will attract young physicians into HIV care, which I've been worried about -- losing some of the romantic ideas about HIV from the early '90s that attracted many young physicians into HIV care. We have not seen that in the last five years. I think if residents and new physicians see that HIV care is a challenge, that it will require a very broad knowledge base but, in addition to that, you have all the science and all the excitement of antiretroviral treatment, I hope we can attract new providers into our field.

Because what is really a fact is that the number of patients with HIV is going to grow, because of increased survival, and that we are going to need more and more providers taking care of these patients. I hope we can attract providers, and that this new challenge of having to have a global knowledge, and global perspective, will attract some clinicians. Because the population of HIV providers is aging. And we need younger people doing this.

Myles Helfand: Are you listening, med students of the United States and Europe?

Pablo Tebas: Today is Match Day in the U.S. [this discussion was recorded on March 18, 2010], so I don't know if they will be listening. But maybe in the future they will. They probably are celebrating, or very worried, where they matched.

Myles Helfand: Well, it sounds like if they end up at U. Penn. that they will be in pretty good hands. It sounds like you might be the kind of person who would try to take a more aggressive stance on their training, to get them to take more things into account than just HIV specifically.

Pablo Tebas: Yes. I think that's one of the most attractive things of being an HIV care provider -- that you have to have a holistic approach to your patients; that you just cannot focus exclusively on HIV issues. All of these issues that people in the past thought were not related to HIV: You know what? They were related to HIV. And they are related to HIV. The increased cancers, the increased cardiovascular disease, the bone issues -- all of that is somewhat related to HIV and its treatment. You need, also, to deal with those.

Myles Helfand: Pablo Tebas is an associate professor of medicine at the University of Pennsylvania School of Medicine. Dr. Tebas, thank you so much for taking the time to talk.

Pablo Tebas: Oh, you are more than welcome.

This transcript has been lightly edited for clarity.

Copyright © 2010 Body Health Resources Corporation. All rights reserved.

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