Ask Dr. Hallberg: New tests, treatments for HIV/AIDS

World AIDS Day was commemorated around the state this weekend, with everything from prayer vigils, to free HIV testing, to a display of panels from the AIDS memorial quilt.

Secretary of State Hillary Clinton released the federal blueprint for an AIDS-free generation saying the goal may be ambitious, but it is possible. Dr. Jon Hallberg, a physician in family medicine at the University of Minnesota, is here now with a status update and some of the latest thinking on HIV/AIDS.

Tom Crann: I suppose the biggest news on this front is the recent recommendation from the U.S. Preventive Services Task Force that all Americans age 15-64 should now be tested. What's behind that?

Dr. Jon Hallberg: Well I think this is building off a 2006 recommendation from the Centers for Disease Control and Prevention that the same group of people get tested, but that was maybe for higher risk folks. This is for everybody. And this is building on a recommendation about hepatitis C. Both of these are viral infections that have infected a lot of people and a lot of people don't know that they have it, and the sooner you know, the better. In the case of hepatitis C, you can be treated, maybe eradicate the virus from your body; in the case of HIV, the sooner you know, you can protect yourself but also prevent transmission.

Crann And is this a way to take stigma and drama away from the testing procedure?

Hallberg: That's exactly it. If we can do that, to minimize this but make it like getting your cholesterol checked, then people are going to get tested and we're going to find out much sooner, and that's fantastic news for public health.

Crann: What's the state of the art in HIV testing, and how has that changed in recent years?

Hallberg: Gone are the days when people would wait weeks and weeks to get a result. My clinic might be a good example. We now have a testing kit in the clinic, basically, where I can test someone for HIV, wait a few minutes while they're still in the lobby, and tell them if it's positive or negative. If it's negative, it's truly negative, if it's reactive or positive, then we'll do another test. We have shaved off days, if not weeks, off of the waiting time.

Crann: Then there's a treatment called Atripla. It's one pill that contains three important drugs. How does it work?

Hallberg: This is part of what we call HAART therapy, or Highly Active Anti-Retroviral Therapy. Basically it stops the HIV virus from making copies of itself. If it can't make copies of itself and replicate, it will not be present. It's one of four mainline therapies and is the best and simplest in that it's three pills in one, one co-pay a month, and it's certainly going to have the highest compliance because it's so simple. But it may not be the right one for everybody, so my colleagues in infectious disease will determine who gets what.

Crann: But it has made a difference in HIV patients' quality of life?

Hallberg: Gone are the days of the handfuls of pills people would take, trying to have these schedules and take things at the right time of day. We all know that the more meds you have to take, the less likely it is that you'll comply with them, so it doesn't get better than one pill a day.

Crann: On the AIDS free generation goal, we have to note that we are still far from there, even here in the U.S., not to mention worldwide, right?

Hallberg: Because we've got a drug like Atripla, word on the street is that if you get an HIV infection, you can take a single pill a day to take care of it, and unfortunately that's sort of a false sense of security, because though the drug can stop making copies of itself, a person with HIV does not have a normal immune system, and this drug does not restore that full immunity, and we don't even know the effects of decades to come and what's going to happen to a person like that in terms of their cancers or other infections they might get, so it sounds so simple but the best thing to do is prevent yourself from getting the virus in the first place.

Crann: Is this an issue that comes up in the clinic on a regular basis?

Hallberg: Yes. I'm surprised, and frankly quite astonished, by just in the last few years how many cases of not just HIV infection, but AIDS I've seen. It's absolutely out there in the United States, even though we think this is something of the past.

Crann: So prevention is of utmost importance?

Hallberg: It sounds so simple, but that's exactly right.

(Interview transcribed by MPR reporter Elizabeth Dunbar)

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