 Joining us for your health tonight is Sarah Smallsley, assistant professor of medicine in the division of infectious disease at the Institute of Human Virology at the University of Maryland School of Medicine. Doctor, thanks for being with us. Thank you for having me. Your work focuses on HIV and AIDS. Where are we at the moment in terms of the spread of the disease and your ability to treat it? Well, HIV is a very different disease than it was back in the 80s when it first started. We now have very effective treatments for it. And so if people are able to actually get tested and know that they're infected, there are multiple different, simple to take one pill once a day regimens that can effectively treat HIV. And if people are treated well, we actually prevent it from spreading to their partners. State of Maryland, city of Baltimore, our numbers are relatively bad. We're high on the list of places where this is prevalent. That's correct. So Maryland is the number two state in the whole country for HIV infection. Baltimore City ranks number four among cities. But we do have some good news. Since 2010, the rate of new infections has actually decreased by about half because of the city's very aggressive and strong prevention and treatment efforts. Still a lot of confusion, maybe among people you talked to about the difference between AIDS and HIV. How do you explain it? Sure, so HIV is a virus. It stands for human immunodeficiency virus. So that means that humans get it and it's a virus that actually damages your immune system. People with HIV can develop AIDS, but they're not the same thing. So AIDS stands for something different. That's acquired immune deficiency syndrome. And that can happen essentially if someone with HIV doesn't get treatment and the HIV progresses to the point that their immune system is weak and can't fight infections and cancers very well. Does it always progress? No, so no one should get AIDS anymore. It's totally preventable as long as people get tested and diagnosed and treated. There's no reason that people's immune system would decrease like it used to in the past. It's still a little bit surprising to people who were around decades ago when this was new and the level of panic was very high that people can live a normal life. Can you live a normal lifespan with HIV? Absolutely, people can live a nearly normal lifespan as long as they get on treatment. So as I said, there's no reason anyone should progress to AIDS, but we see it happen if people don't get diagnosed early enough in their disease or if people don't stay on treatment. Let me remind our viewers if you have a question about HIV and AIDS, give us a call, we'll have the number on the screen or email your question to livequestions.mpt.org. Any sense of how many undiagnosed people are walking around? The number is probably about 10% of all infections about 10% are probably undiagnosed. In Baltimore, the biggest group actually with undiagnosed infections is kind of surprising, it's youth. So people age 13 to 24 are the most likely to have HIV and not know it. So what you're saying is huge advantage to being tested, getting on the right medications. Reluctance to do it, maybe it costs money, maybe you don't wanna know that you have a disease that you still perceive as being terminal. So we encourage every single person to get tested as part of the routine healthcare. There's free HIV testing throughout the city at multiple sites and any doctor's office can do it. If people do have HIV, it's easy to get in treatment. If people don't have the money to do it, there's state grants that will cover treatment, there's grants that will cover medication. So essentially there's no reason financially that anyone should not go ahead and get tested and treated. Should it be automatic? I mean, should it be when somebody gets some routine lab work that it's just automatically done? Absolutely. So we've set up programs like that at University of Maryland. So people come in through the emergency room, people getting admitted to the hospital. We encourage every single person to get tested. But they have to agree to it. You're not just running the test. Yeah, and the easy way to get everyone tested is just to kind of explain some of these things that it should be part of the routine healthcare. We know that when doctors try to select people that they think have HIV, they don't do a good job because anyone can have HIV. You mentioned you're treating somebody who was diagnosed in his 80s? Yeah, yeah. One of my patients a few years ago was diagnosed in his mid 80s. And if you looked back, you could see that he had all the signs of advancing HIV disease, probably for a decade, and no one thought to check an HIV test because people often don't think about it in older people, but it definitely happens. I mean, half of the patients at the clinic that I work at and run are over 50. You just wonder from, and it's a public health question, not for you, but should, I mean, if everybody was tested, a lot of people would know and wouldn't go on spreading it and so forth. Let's take a phone call. Anne Arundel County, this is George. George, thanks for calling. Go ahead. Thank you. I wonder since the disease progresses or can progress from HIV to AIDS, is there any difference in the amount of infectious or communicability between those two stages? So would you be more likely to pass it on if you were at the AIDS stage versus the HIV? George, great question. Thank you, sir. That is a great question. So everyone's a little bit different in terms of how much HIV they have circulating in their blood, but as people do progress to end stage AIDS, it is much more likely that they have a high, what we call viral load, which means a lot of circulating virus and does mean it's more communicable. You brought a pill kit. I did. Very familiar. Every drug store sells these things. Let's hold it up so everybody can see. And this one has like two boxes for every day of the week, right? Okay. Why did you bring this? I brought it to show. So if you can see in each of these, just in the morning section, there's one pill in here because there's about a dozen different treatment regimens for HIV that are one pill once a day. And generally people don't have side effects and tolerate them very well. And you can maybe see that it's actually a pretty small pill. So it's quite easy to take compared to the regimens of 15 years ago that were 20 or 30 pills a day. You read about something called PrEP. Yes. What is that? So PrEP is PREP, it stands for pre-exposure prophylaxis. So that means if someone is at higher than average risk of getting HIV, they can actually take an HIV pill once a day and decrease their risk of transmission by up to 99%. How do you feel about that? I think it's fantastic. Baltimore is having a hard time getting enough people on it to have a major effect on transmission from a public health standpoint because people have a lot of competing priorities and a lot of the people that are at highest risk also have a lot of other stuff going on. So if people are struggling with housing or food or violence, preventing HIV for the long term might not be the first thing on their mind. Is there a fear maybe that people who are on it feel invincible and might engage in high-risk behavior? So that was one of the major concerns when it came out and there were a lot of groups kind of speaking out against it, but the data has shown that that's not really the case and it's a really effective treatment strategy or I'm sorry prevention strategy for HIV so we strongly recommend it. Do you know from the people you treat and is there a way to tell how they acquired the virus? I mean whether it was sexual activity, whether it was drug use or whatever. We can't tell by anything medical but people will often tell us what their risk factor may have been. The big reasons that people can get HIV would be contact with blood, genital fluid or breast milk from someone living with HIV and so there's many ways that you can come into contact with it, the two biggest being sex and drug use but what we really see in Baltimore is sex being the highest risk but you can get it anyway and really anyone having sex in Baltimore based on our numbers is at risk for HIV. What should people know about the behaviors that are hard to change in that regard? What they can do to protect themselves, protect their partners? So the main things we think about with prevention are getting everyone tested so that we know. Medication based prevention strategies like PrEP and there's something we call treatment as prevention which means that if someone does have HIV if they get on treatment and it's effective they can't pass it on to their partner so we call that treatment for the patient prevention for the partner and then the last thing as you said is behavioral strategies. Maybe there's somebody watching who realizes that they ought to get tested, maybe doesn't want to talk to their primary care doctor for whatever reason, where do they go? There are loads of different free testing facilities throughout the city. I work at University of Maryland and we have at the Midtown Campus the Community Health Education Center that does testing and also the Jocs Initiative which we partner with and they do testing at their journey center. Very good, Dr. Sarah Smallsley, University of Maryland School of Medicine. Doctor, thanks very much. Yeah, thank you. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.