HIV Researchers Weigh In on Ebola Outbreak

Executive Editor
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With the Ebola outbreak making headlines, many have drawn comparisons to the early days of the AIDS epidemic. We asked HIV researchers and clinicians what their opinions were on the current Ebola epidemic.

Paul Sax, M.D.

Dr. Sax is director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital in Boston.

Right now there is so much fear, and a lot of it is groundless. And yet, there is a real threat here, too. And so you need to balance what's known about transmission from a scientific perspective, and be very careful with trying to reassure people that this is not going to suddenly sweep through the United States, killing thousands and thousands of people -- because that's simply not going to happen.

I have to try to, as an HIV specialist, as an infectious disease specialist, provide some perspective on this, which is very hard with something that's so new, and so scary.

David Wohl, M.D.

Dr. Wohl is an associate professor of medicine at the University of North Carolina School of Medicine and the co-director of HIV services at the North Carolina Department of Corrections.

I think it's really interesting. In my small circle, I've been impressed by how this has kind of touched buttons for some people, that this is very reminiscent in ways of the early days of the HIV epidemic, where people didn't want to touch people with HIV. We were fearful.

Abraham Verghese in his book My Own Country eloquently pointed out how they would vary the ventilators that they used in patients who had PCP. People would gown up.

So, there's a fear factor that surrounded early HIV that presented a barrier to care, and we're seeing that, of course, with Ebola -- a much more transmittable infectious agent, one more lethal.

So, there are parallels there. And there are people, such as myself, who are feeling a call to respond. I wouldn't be surprised if we see more people who've been used to dealing with HIV respond than people who haven't.

So, I think it's a big deal. I think Ebola is scary. And I think that those poor people are suffering. And I would like to help. I think that many people with HIV experience would like to help, too.

Lisa Fitzpatrick, M.D., M.P.H.

Dr. Fitzpatrick is a professorial lecturer for the George Washington University School of Pubic Health, and an adjunct faculty member in the Howard University College of Medicine.

I am fascinated at how the media coverage was so skewed toward Americans relative to the epidemic in Africa. I also think we, the U.S., have demonstrated that early access to state-of-the-art medical care renders the virus impotent. The U.S. survivals are in stark contrast to the alarmingly high mortality rates in West Africa. This is all about healthcare access and infrastructure. Also, the stigma we are seeing toward Africans and Ebola patients makes me embarrassed and ashamed.

Jen Kates, Ph.D.

Dr. Kates is Vice President and Director of Global Health Policy and HIV at the Kaiser Family Foundation.

There is so much to say about what HIV can teach us about the current Ebola outbreak, in so many areas. The one I want to highlight is this -- HIV, and just about every epidemic throughout history, have been met by stigma, rooted in fear. And stigma is the enemy of public health. We have learned a lot about this from HIV and I hope that some of these lessons can start to be applied to the Ebola response.

Sharon Dian Lee, M.D.

Dr. Lee is an assistant clinical professor of medicine at the University of Kansas and the founder and director of Southwest Boulevard Family Health Care.

Ebola is a concerning virus as it can be transmitted through relatively "casual" contact and has a very high fatality rate. Most other serious or fatal diseases in the modern era that involve human-to-human transmission (tuberculosis, HIV) have generally been spread through more sustained or intimate contact. The greatest concern I have regarding Ebola in the U.S. is that politicians meddling in medical and public health decision-making can make great mistakes curtailing justice in the name of protection. Possible unintended consequences need to be illuminated with as much science as possible before plans are implemented that may cause more harm.

Theo Katsivas, M.D.

Dr. Katsivas is an associate physician at the Owen Clinic at the University of California, San Diego.

I'm not an Ebola expert, but I think we are facing this early on, and practically. I know many of us are ready already. And I know many hospitals in the U.S. are ready to face cases. I don't think the cases are going to be extremely many. It's a problem that is focused in West Africa for now. It's very appropriate that we are trying to help on the field there. This is where the battle should be given, but I think that we should be prepared. And I think we are prepared.

So, I feel very comfortable about this outbreak. I understand the concern, but I wouldn't panic. I wouldn't have any problem walking into a patient's room who might be an Ebola patient, given the protective equipment that I would have to don. We will be fine.

Pablo Tebas, M.D.

Dr. Tebas is an associate professor of medicine at the University of Pennsylvania School of Medicine and principal investigator in the AIDS Clinical Trials Unit (ACTU) at the University of Pennsylvania.

Well, I am an infectious disease doctor. I love infectious diseases. And I like the fact that we can help people with these new problems to try to deal with them. Ebola is a tragic disease. It reminds me of the beginning of the HIV epidemic, all the issues about stigmatization and the difficulty taking care of these very sick patients. And I think we can learn, in managing Ebola, what we learned in the late '80s and the late '90s -- that we need to care about people that have these very difficult diseases. If we put our mind and our effort in doing that, we will be able to improve outcomes and try to develop a solution quickly for this problem.

It's understandable that the focus is on Ebola. Everybody feels vulnerable. The magnitude of the problem is completely different from HIV; there are 40 million people infected with HIV, 7,000 people with Ebola. But it's an important problem that we need to address.

Roy Gulick, M.D.

Dr. Gulick is a professor of medicine and chief of the Division of Infectious Diseases at Weill Medical College of Cornell University, and an attending physician at the New York Presbyterian Hospital in New York City.

Well, there certainly are parallels, where a virus seemingly comes out of nowhere. This one, Ebola, rapidly spreads between people. It's in an area of the world that doesn't have a lot of resources, in terms of even trying to protect person-to-person transmission. It has rapidly become a health crisis, not just for the countries, the three countries, where it's rampant, but also the rest of the world. It reminds us (another parallel with HIV) that air travel can spread diseases from one corner of the globe to the other pretty quickly. And it's sort of a lesson to us.

Many people have said, "This reminds me of HIV, back in the day, with a high mortality rate. And are we doing enough?" -- the kinds of questions that we thought we had answered once and for all for HIV and are now being reposed with Ebola.

Henry Masur, M.D.

Dr. Masur is a clinical professor of medicine at George Washington University and chief of the Critical Care Medicine Department at the NIH Clinical Center.

The Ebola outbreak is clearly a global catastrophe. It's a catastrophe for a significant population that has very few health care resources and very few options, both for avoiding infection in their communities, and for getting treated. At the same time, we have to recognize that, at the moment, it's a relatively small outbreak (7,000 patients) compared to the millions of patients (35 million), who have HIV globally.

So, while it's a small outbreak, and we have to put it in that kind of perspective, we also have to learn the lesson we learned about HIV 30 years ago. If you don't intervene quickly, if you don't intervene effectively on a global basis, this could become a global problem -- not necessarily in the developed world, in the developing world.

While I think the numbers are small, and we have to put it in perspective, and while it is, in some ways, an interesting commentary on our society that a few patients in the United States get a huge amount of publicity, compared to many patients who have HIV or other chronic diseases which will kill them, but for which we don't put in nearly the same resources. Yet, at the same time, this is the time to act. Because if we had acted faster and more effectively in the HIV epidemic, we wouldn't have as many patients globally as we do now.

Michael Saag, M.D.

Dr. Saag is a physician and HIV researcher at the University of Alabama at Birmingham.

Well, I just don't think it's anything new. It's a terrible disease that's basically an indictment of health care systems that aren't robust. And if you have a good health care system, and you're able to do case contact tracing and use good public health, then you can get it under control. And that's typically what's happened.

What's interesting is that if you look at the countries that are struggling with it right now, the Western African countries, none of them are PEPFAR countries. And when it hit in Nigeria just briefly, they were able to contain it, whereas the other countries aren't.

There are a lot of reasons, but part of the reason I think that these other countries have had the success is that when PEPFAR comes in, the entire infrastructure rises and they're able to deal with things a lot quicker, in a more straightforward way, without being overwhelmed.

One other thing that's quite interesting, and it gets directly at your question, is there's got to be an intersection between Ebola and HIV. A lot of those people who are coming down with it have got to be coinfected. They're so overwhelmed, no one's looking. But it's got to be something there. And I think maybe in retrospect they will be able to see that mortality is higher.

Kenneth Mayer, M.D.

Dr. Mayer is a professor of medicine and community health at Brown University and an attending infectious disease physician at Miriam Hospital.

I think that it really underscores the importance of public health and the importance for putting resources into public health infrastructure. I think the fact that we're kind of making it up as we go along with temperatures at airports is not really very well thought-through public health policy. Because if somebody wanted to game the system, they could take Tylenol [acetaminophen] before their temperature is measured. And it's all the timing of the incubation period.

I think what's really needed is, rather than having the appearance of action with less technically trained people being involved, is if there was more funding for epidemiology, intelligence services, front line -- people in training who could be dispatched.

Because what's happening now is they're just sort of pulling people from programs, like an all-hands-on-deck kind of thing. So, there are a lot of people involved in AIDS work, for example, who are just told, "Forget it. Go to Liberia. Go to Sierra Leone."

So, hopefully we realize that there are always going to be new epidemics and new outbreaks and that investing up front and having good public health infrastructure is really what we need to do.