'Stop it in its tracks' -- HIV: From undetectable to eradication

Sep. 24—TRAVERSE CITY — Jeff Lange has been HIV-positive for 11 years.

He was living in Sydney, Australia, when he was diagnosed. His first concern was how he would pay for treatment without any health insurance.

If Lange had been diagnosed in the 1980s, imminent death would likely have been first and foremost in his mind.

Instead, every two months, the Traverse City resident gets injections of Cabenuva, a long-lasting HIV treatment medication that came on the market nearly two years ago.

"I knew it wasn't a death sentence," said Lange, 41. "I knew that it was just something that I would have to manage for the rest of my life. I knew that was possible."

Decades of research have resulted in a cluster of new medications and newly combined medications aimed at reducing the viral load of the disease, making it undetectable and untransmittable. They also have fewer side effects, which helps people stay on the drugs.

Pre-exposure prophylactic (PrEP) medications are also available for those who are at high risk of contracting HIV, as well as medications that can be taken after a known exposure.

"HIV is a public health issue," said Heidi Lovy, community education specialist at the Thomas Judd Care Center in Traverse City. "It is also very treatable and preventable.

"We have all the tools now to treat HIV and stop it in its tracks."

The center provides treatment and support for about 150 people living with HIV in 31 northern Michigan counties, and PrEP medications for about another 100 people, Lovy said.

On Friday it will host the 2023 Northern Michigan HIV Summit set for 10 a.m. to 3 p.m. at Kirkbride Hall in The Village at Grand Traverse Commons. The event is for healthcare professionals and for the public.

Testing is a core mission of the center, which travels around northern Michigan to do free testing. Free rapid testing is done in the office and free home test kits are provided for people to swab their mouths and have results in 20 minutes.

THEN AND NOW: HIV INCIDENCE

The first cases of pneumocystis pneumonia, later named AIDS (Acquired Immune Deficiency Syndrome), were reported in June 1981 by the Centers for Disease Control after a group of five healthy young gay men in Los Angeles contracted the rare lung infection.

The human immunodeficiency virus responsible for the disease was isolated two years later, in May 1983.

According to the CDC, the annual incidence in the United States rose from an estimated 20,000 HIV infections in 1981 to 130,400 newly-diagnosed infections in 1984-'85. From 1991 to 2007, new infections stabilized at about 50,000 to 58,000 per year and then fell to 34,800 infections in 2019.

In those early years, about 95 percent of those who were diagnosed died, sometimes within just a few months; by 2000, that rate had dropped to about 23 percent, the CDC reports.

In Michigan, 634 people were newly HIV positive in 2022, down from a high of about 1,500 cases in 1992.

Lovy said that, over the last couple of years, the center has seen an uptick in positive HIV results in northern Michigan. There also has been an increase in HIV among those who identify as heterosexual, she said.

"What we're realizing is that some of our new diagnoses are coming from folks who've had HIV for a while, but weren't tested," Lovy said.

The longer a person is HIV positive and doesn't know it, the higher the viral load and the higher the chance to develop symptoms of what is now called HIV Stage 3.

As an older, married, heterosexual woman, Lovy said her doctor never asks her about her sexual health.

"We believe that is common — and we believe that is a mistake," she said.

She said if a doctor brings up the issue, rather than waiting for the patient, people tend to be more open, Lovy said.

BECOMING UNDETECTABLE

When the virus can't be measured in the blood of a person with HIV, that person cannot transmit the disease. That's the goal of medications, although in the early days people sometimes took up to 20 pills a day, all at different times, said Shawn Kintigh, a nurse practitioner at the Judd Center.

The medications often caused severe side effects — lots of vomiting and diarrhea, Kintigh said. Some had psychological effects — vivid dreams, nightmares or depression, she said.

The regimen was difficult and many found it hard to stick with it. Now some people can take one pill once a day and have very few side effects, she said.

'You can take a pill with or without food; you can take it in the morning or the evening; and, if you miss a pill, you can take it up to 12 hours later," Kintigh said.

The Affordable Care Act also changed requirements, making it possible for those with HIV to get health insurance they can afford.

"It used to be people living with HIV were not allowed on insurance programs due to pre-existing conditions," Kintigh said.

There also are state programs that pay insurance premiums and medication co-pays for those who don't qualify for Medicaid. The programs were created to keep people virally suppressed, which is in the best interest of society, she said.

Lange said his insurance premium is $500 per month, his out-of-pocket costs for his injections are $1,900 per dose, and each visit to the infusion clinic is $12,000. All of his costs are covered by the Judd Center, which is grant-funded by the state of Michigan.

"We're at a place where, if you know your status, you can have a normal life," Kintigh said. "You can have children ... do all the things other people do and live a normal life span."

Now that treatment is to that point, the focus is on getting high-risk people on PrEP — as well as identifying people with HIV to stop the spread and eradicate the disease.

"There are lots of people living with HIV — they just don't know it," she said.

Lange said that, despite medical advances, there is still a lot of stigma around being HIV-positive. He thinks it's because of the lack of education about the disease.

Lange has always been open about his diagnosis and does a lot of outreach in the community. He recently completed training as a sexual health ambassador with Planned Parenthood.

"There's no reason we can't end this epidemic, but we have to talk about sex," he said. "We just don't talk about sex enough."