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Despite advances, HIV care still a challenge (UAB)
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Sunday, August 05, 2007
DAVE PARKS
Birminhgham News, News staff writer
Almost 15,000 people in Alabama have been infected with HIV since the AIDS epidemic began more than two decades ago, and about two-thirds of them are still alive.
These survivors often require special nursing care. Recently, Jim Raper, a nurse practitioner and director of the 1917 Clinic for HIV/AIDS at the University of Alabama at Birmingham, was recognized by the American Academy of Nurse Practitioners for his dedication in caring for these patients.
Here is his expert opinion:
What are the biggest challenges in caring for patients with HIV?
I think one challenge involves the rapid pace at which information is learned, staying abreast of everything that is happening, staying on the cutting edge.
And then there's dealing with people. As the epidemic has changed over the past 10 to 15 years, it has really focused more on the disenfranchised, people in poverty.
It's a lot more challenging to garner resources, to work with people who might not have the same access to health care, might not have the same access to support services. And they don't always have the best ability to navigate a system that is becoming increasingly complex.
It's a real challenge to navigate the United States health care system. I think that's probably the biggest challenge we face here.
What kind of patient load do you have at the 1917 Clinic?
We see a little more than 1,500 patients, and I take care of a little more than 400 of them. It's a pretty good sized group of patients.
What portion of that number is people with HIV in the area?
I think there are about 700 (HIV) patients who go to Cooper Green (Mercy Hospital). And there are about 250 who go to the VA hospital. And that's really about all the HIV patients in the area.
We take care of the bulk of patients in north central Alabama. There's a clinic in Huntsville and there's a clinic in Anniston that probably see 200 patients each.
The Montgomery AIDS Outreach is a large consortium of traveling roadshows that moves all over South Alabama taking care of patients. They actually take care of more patients, but they have a much, much larger geographic area.
With AIDS, don't you end up dealing with a lot of complications?
Absolutely. Practitioners and physicians who provide care to people with HIV today are not only their primary care doctors but they are also their linkage to sub-specialists. At UAB all the physicians who work here are infectious disease doctors. So they are very specialized anyway.
It's really a very comprehensive situation we have over here. A lot of services are available to manage very complex situations.
Do you perceive a sense of complacency among people about HIV/AIDS now that we have the drug cocktails?
There may be a sense of complacency in the general population. There's a sense that there are good medicines available, and if somebody gets infected, they will be taken care of, and it's a chronic illness. And so things are OK.
The reality is people are still dying every day with AIDS. People are still not coming to (get) care. They don't get diagnosed until they are very, very sick.
I just recently had a guy that had been diagnosed for 18 months. He died without taking his first dose of HIV medicine. It was just one illness after another, and he never got well enough and never got engaged enough with the health care system to actually start taking HIV medicine.
So this isn't a slam dunk?
No, it's not. It takes the three Ps: Patience, persistence and perseverance, to work with this type of population.
Aren't the drug regimens complicated?
It's interesting. For the new patients who are coming in, the drug combinations have been tremendously simplified. Most newly diagnosed patients go on one pill, one time a day. It's a combination pill. It has three medicines in one pill.
Is there a new type of AIDS drug coming on line?
It's called an integrase inhibitor. The integrase inhibitor is totally a new class, and they're very well tolerated. They don't have a lot of side effects. Generally it's a twice a day medicine; that's the only drawback. But it's highly effective.
Who will get these new drugs?
Initially it will be late-stage patients who need salvage therapy, people who've been through a lot of other medicines and were either intolerant to the medicines or developed resistance. But I foresee that it will eventually be a widely used medication because it is so well tolerated.
Are people developing the resistance to AIDS medications the same way they are developing resistance to antibiotics?
Yes. It's mostly seen because people miss medications. Generally, Americans don't do a good job taking medication. It's hard to do the same thing every day. Even diabetics who have to take injections twice a day will miss medicines. We live busy lives and complicated lives, and people miss medicine. And when people miss medicine, they develop resistance, and the medicine doesn't work anymore.
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