In this episode of Going anti-Viral, Dr Michael Saag speaks with Dr Kevin Carmichael of the Arizona Department of Health Services about the unique challenges caregivers faced in addressing the HIV/AIDS pandemic. Dr Carmichael is a family physician who began work in HIV in 1983 while in medical school in Miami, Florida. During his residency at the University of Miami, Dr Carmichael co-authored one of the first written guidance for clinical HIV care “HIV/AIDS: A Primary Care Handbook.” Dr Saag and Dr Carmichael discuss their shared history in caring for people during the early years of HIV and AIDS in the 1980s and 1990s. They also discuss the challenges in managing families of people with AIDS. Dr Carmichael then reflects upon the transition in the care of HIV in 1995 when protease inhibitors became available, effectively the start of turning HIV into a manageable chronic disease. Finally, Dr Saag and Dr Carmichael provide thoughts for younger practitioners currently involved in HIV management.

0:00 – Introduction

1:22 – A discussion of the early years of HIV and AIDS care in the 1980s

7:43 – How Dr Carmichael came to focus on HIV and AIDS care

12:36 – Dr Carmichael’s transition to care in Arizona and differences from his time in Miami

16:08 –Discussion of advanced AIDS and working with families of people with HIV at the time

23:12 – The arrival of protease inhibitors in 1995 and the transition to management of a chronic disease

31:00 – Closing remarks and reflections for younger practitioners involved in HIV care

__________________________________________________

Produced by IAS-USA, Going anti–Viral is a podcast for clinicians involved in research and care in HIV, its complications, and other viral infections. This podcast is intended as a technical source of information for specialists in this field, but anyone listening will enjoy learning more about the state of modern medicine around viral infections.

Going anti-Viral’s host is Dr Michael Saag, a physician, prominent HIV researcher at the University of Alabama at Birmingham, and volunteer IAS–USA board member. In most episodes, Dr Saag interviews an expert in infectious diseases or emerging pandemics about their area of specialty and current developments in the field. Other episodes are drawn from the IAS–USA vast catalogue of panel discussions, Dialogues, and other audio from various meetings and conferences.

Email podcast@iasusa.org to send feedback, show suggestions, or questions to be answered on a later episode.

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Episode 33 - Overview of Travel Medicine: Vaccines, Outbreaks, and More - Dr David Freedman

In this episode of Going anti-Viral, Dr Michael Saag speaks with Dr David Freedman of the University of Alabama at Birmingham to provide an overview of travel medicine: vaccines, outbreaks, and more. Dr Freedman is a professor of infectious diseases and his research is focused on clinical tropical medicine, including the development of surveillance networks to characterize infectious disease morbidity in travelers and migrants. Dr Saag and Dr Freedman provide an overview of worldwide outbreaks such as: mpox, H5N1, Marburg virus, Ebola, dengue fever, chikungunya, and Zika virus. Dr Freedman discusses the treatments and vaccines available for each of these outbreaks. They also address the clinical challenges of treating individuals with emerging infections of unknown origin. Finally, Dr Saag and Dr Freedman address the acute setting of treating rabies exposures from bats and other wild animals.

0:00 – Introduction

1:11 – Overview of surveillance networks and current areas of concern

4:01– Discussion of mpox outbreaks including a new clade in the Democratic Republic of the Congo

7:10 – Risk of H5N1 human transmission

10:07 – Update on Marburg virus disease

12:22 – Current status of Ebola disease and availability of monoclonal antibodies for treatment

15:53 – Overview of outbreaks in the Caribbean: dengue fever and chikungunya

25:08 – Update on Zika virus

26:36 – Discussion of how to clinically address cases of emerging viruses like Oropouche virus

29:50 – How to prevent and treat rabies exposures from bats and other animals

__________________________________________________

Produced by IAS-USA, Going anti–Viral is a podcast for clinicians involved in research and care in HIV, its complications, and other viral infections. This podcast is intended as a technical source of information for specialists in this field, but anyone listening will enjoy learning more about the state of modern medicine around viral infections.

Going anti-Viral’s host is Dr Michael Saag, a physician, prominent HIV researcher at the University of Alabama at Birmingham, and volunteer IAS–USA board member. In most episodes, Dr Saag interviews an expert in infectious diseases or emerging pandemics about their area of specialty and current developments in the field. Other episodes are drawn from the IAS–USA vast catalogue of panel discussions, Dialogues, and other audio from various meetings and conferences.

Email podcast@iasusa.org to send feedback, show suggestions, or questions to be answered on a later episode.

Follow Going anti-Viral on:
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In this episode of Going anti-Viral, Dr Michael Saag speaks with Dr Rajesh Gandhi of Harvard Medical School and Massachusetts General Hospital about the new IAS-USA recommendations for HIV treatment and prevention. Dr Gandhi is the Chair of the guidelines panel, which published its recommendations in the Journal of the American Medical Association on December 1, 2024. Dr Gandhi and Dr Saag discuss the process by which the updated guidelines were created and provide an update on what’s new in the current edition. They address other important topics like how to treat patients with opportunistic infections, guidance on when to change therapy, and strategies for preventing HIV acquisition. Finally, Dr Gandhi makes recommendations for those using the guidelines, especially those using them for the first time.

0:00 – Introduction

1:19 – Overview of the guidelines’ creation process

3:52– New recommendations on when to start antiretroviral therapy

6:37 – New guidance on what regimens to start

9:34 – Discussion of other agents like bictegravir and dolutegravir in pregnancy

10:45 – How to treat patients with an opportunistic infection

14:09 – Concern about immune reconstitution inflammatory syndrome (IRIS)

16:33 – Guidance on when to change therapy and providing support

21:18 – How do the guidelines help people stay healthy – management of cancer, cardiovascular risk, and weight gain

24:41 – Discussion on prevention of HIV and sexually transmitted diseases

30:19 – What could not be addressed in the guidelines

33:17 – Final comments and how to use the guidelines

Resources: https://jamanetwork.com/

__________________________________________________

Produced by IAS-USA, Going anti–Viral is a podcast for clinicians involved in research and care in HIV, its complications, and other viral infections. This podcast is intended as a technical source of information for specialists in this field, but anyone listening will enjoy learning more about the state of modern medicine around viral infections.

Going anti-Viral’s host is Dr Michael Saag, a physician, prominent HIV researcher at the University of Alabama at Birmingham, and volunteer IAS–USA board member. In most episodes, Dr Saag interviews an expert in infectious diseases or emerging pandemics about their area of specialty and current developments in the field. Other episodes are drawn from the IAS–USA vast catalogue of panel discussions, Dialogues, and other audio from various meetings and conferences.

Email podcast@iasusa.org to send feedback, show suggestions, or questions to be answered on a later episode.

Follow Going anti-Viral on:
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In this episode of Going anti-Viral, Dr Michael Saag speaks with Dr Kenneth Sherman of Massachusetts General Hospital and Harvard Medical School about the possibility of a cure for hepatitis B. The World Health Organization estimates that 254 million people were living with chronic hepatitis B globally in 2022. Dr Saag and Dr Sherman discuss the lifecycle of hepatitis B including the role that covalently closed circular DNA (cccDNA) plays in the hepatitis B virus (HBV) replication cycle. Dr Sherman defines functional cure and provides an overview of the most promising cure strategies. They also discuss whether antiretroviral drugs like tenofovir, used in the treatment of HIV, can contribute toward a functional cure of hepatitis B. Dr Sherman discusses other strategies like capsid assembly modulators (CAMs), monoclonal antibodies, and toll-like receptor (TLR) agonists. Finally, they discuss the effectiveness of the hepatitis B vaccine in prevention and look forward to the future by considering a timeline for a cure based on the status of ongoing clinical trials.

0:00 – Introduction

1:23 – Overview of the lifecycle of hepatitis B

5:29 – Discussion of the most promising cure strategies

7:11 – Defining functional cure

10:56 – The role of drugs like tenofovir in a functional cure

13:39 – Targets that can affect viral production

16:04 – Potential of capsid assembly modulators (CAMs)

18:03 – Other strategies like immune modulators and monoclonal antibodies

22:29 – Interest in toll-like receptor (TLR) agonists and therapeutic vaccines

24:32 – Outlook for the future and the effectiveness of a hepatitis B vaccine in prevention

__________________________________________________

Produced by IAS-USA, Going anti–Viral is a podcast for clinicians involved in research and care in HIV, its complications, and other viral infections. This podcast is intended as a technical source of information for specialists in this field, but anyone listening will enjoy learning more about the state of modern medicine around viral infections.

Going anti-Viral’s host is Dr Michael Saag, a physician, prominent HIV researcher at the University of Alabama at Birmingham, and volunteer IAS–USA board member. In most episodes, Dr Saag interviews an expert in infectious diseases or emerging pandemics about their area of specialty and current developments in the field. Other episodes are drawn from the IAS–USA vast catalogue of panel discussions, Dialogues, and other audio from various meetings and conferences.

Email podcast@iasusa.org to send feedback, show suggestions, or questions to be answered on a later episode.

Follow Going anti-Viral on:
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In this episode of Going anti-Viral, Dr Michael Saag speaks with Dr Jason Zucker of Columbia University and the New York City STD Prevention Training Center about mpox and the mpox outbreak. Dr Saag and Dr Zucker discuss the 2 clades of mpox, how it is transmitted, and which clade is associated with the most recent mpox outbreak. They also discuss how to test for mpox and how people with HIV present with mpox based on their HIV viral load. Dr Zucker gives a detailed update on the STOMP (Study of Tecovirimat for Human Mpox Virus) trial that evaluates the efficacy of the antiviral tecovirimat, also known as TPOXX, for the treatment of mpox. They also address the role of vaccination in mpox, its uptake and efficacy. Finally, Dr Zucker offers his perspective on how practitioners and public health officials can address ongoing mpox outbreaks in the US and globally, including a second public health emergency of international concern that was declared in the Democratic Republic of the Congo and surrounding countries in August by the World Health Organization (WHO).

0:00 – Introduction

1:25 – Description of mpox and its 2 clades

2:07 – Overview of the current mpox outbreak

3:11 – Mpox transmission

4:29 – Mpox in people with HIV

6:35 – Testing for mpox

9:05 – The STOMP study, enrollment, and effectiveness of tecovirimat

15:58 – The role for vaccination for mpox and who should receive it

20:38 – Outlook for the future

__________________________________________________

Produced by IAS-USA, Going anti–Viral is a podcast for clinicians involved in research and care in HIV, its complications, and other viral infections. This podcast is intended as a technical source of information for specialists in this field, but anyone listening will enjoy learning more about the state of modern medicine around viral infections.

Going anti-Viral’s host is Dr Michael Saag, a physician, prominent HIV researcher at the University of Alabama at Birmingham, and volunteer IAS–USA board member. In most episodes, Dr Saag interviews an expert in infectious diseases or emerging pandemics about their area of specialty and current developments in the field. Other episodes are drawn from the IAS–USA vast catalogue of panel discussions, Dialogues, and other audio from various meetings and conferences.

Email podcast@iasusa.org to send feedback, show suggestions, or questions to be answered on a later episode.

Follow Going anti-Viral on:
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In this episode of Going anti-Viral, Dr Michael Saag speaks with Dr Jennifer Kates of KFF to compare and contrast health care policies from different sides of the aisle. Dr Kates provides an update on the Patient Protection and Affordable Care Act (ACA) and efforts to repeal the healthcare program in the United States. Dr Saag and Dr Kates also discuss the status of Medicaid expansion in the US and the impact of access to care in states where Medicaid has been expanded. They also discuss the impact of the Ryan White HIV/AIDS Program on healthcare for people with HIV and the long-term outlook for funding for the program. In addition, there is a detailed overview and outlook of funding for the 340B Drug Pricing Program that allows eligible hospitals and other healthcare organizations to purchase outpatient drugs at a discount from pharmaceutical manufacturers. Finally, Dr Saag and Dr Kates discuss the erosion of trust in science and public health officials in the US and reasons to be optimistic for the future.

0:00 – Introduction

1:15 – Update on the ACA

3:19 – Discussion of efforts to repeal the ACA

5:32 – Status of Medicaid expansion in the US

8:56 – Overview of access to HIV care through Ryan White

10:37 – Access to health insurance coverage through Ryan White

12:31 – What is 340B funding?

15:45 – Possible pressures on 340B funding

17:45 – Outlook for Ryan White funding and availability of PrEP in the program

21:34 – Discussion of the erosion of trust in science and public health

26:42 – Outlook for the future

__________________________________________________

Produced by IAS-USA, Going anti–Viral is a podcast for clinicians involved in research and care in HIV, its complications, and other viral infections. This podcast is intended as a technical source of information for specialists in this field, but anyone listening will enjoy learning more about the state of modern medicine around viral infections.

Going anti-Viral’s host is Dr Michael Saag, a physician, prominent HIV researcher at the University of Alabama at Birmingham, and volunteer IAS–USA board member. In most episodes, Dr Saag interviews an expert in infectious diseases or emerging pandemics about their area of specialty and current developments in the field. Other episodes are drawn from the IAS–USA vast catalogue of panel discussions, Dialogues, and other audio from various meetings and conferences.

Email podcast@iasusa.org to send feedback, show suggestions, or questions to be answered on a later episode.

Follow Going anti-Viral on:
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This episode of Going anti-Viral features an IAS–USA Dialogue titled "Latest Update on Urgent Viral Outbreaks," a panel discussion held on October 4, 2024. Dr Carlos del Rio from Emory University serves as moderator and welcomes 3 distinguished panelists: Dr Yvonne Maldonado from Stanford University, Dr Peter Chin-Hong from the University of California San Francisco, and Dr Paul Sax from Brigham and Women’s Hospital.

The episode covers various pressing topics, including updates on COVID-19, avian flu, mpox, and other viral diseases. Discussions touch on vaccines, their effectiveness, public health approaches, and current research.

0:00 – Introduction and overview of ongoing viral outbreaks

3:59 – Update on respiratory viruses and vaccination – seasonal flu, RSV, and COVID-19

12:17 – Discussion of monoclonal antibody treatment for COVID-19

14:15 – Update on the use of Paxlovid for COVID-19

18:48 – COVID-19 vaccination – protein vaccines vs. mRNA vaccines

22:48 – Update on pertussis

28:54 – Discussion of seasonal influenza and vaccination

32:55 – Effectiveness of shingles and RSV vaccines

35:57 – Discussion of vaccination during pregnancy

40:02 – Audience questions

43:04 – Update on H5N1 (avian flu) outbreak

52:00 – Update on Marburg virus outbreak in Rwanda

55:43 – Discussion of mpox outbreak in central Africa

59:29 – Concluding remarks

__________________________________________________

Produced by IAS-USA, Going anti–Viral is a podcast for clinicians involved in research and care in HIV, its complications, and other viral infections. This podcast is intended as a technical source of information for specialists in this field, but anyone listening will enjoy learning more about the state of modern medicine around viral infections.

Going anti-Viral’s host is Dr Michael Saag, a physician, prominent HIV researcher at the University of Alabama at Birmingham, and volunteer IAS–USA board member. In most episodes, Dr Saag interviews an expert in infectious diseases or emerging pandemics about their area of specialty and current developments in the field. Other episodes are drawn from the IAS–USA vast catalogue of panel discussions, Dialogues, and other audio from various meetings and conferences.

Email podcast@iasusa.org to send feedback, show suggestions, or questions to be answered on a later episode.

Follow Going anti-Viral on:
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In this episode of Going anti-Viral, Dr Michael Saag speaks with Dr Carolyn Chu and Dr Lealah Pollock from the University of California San Francisco about the National Clinician Consultation Center (NCCC). The NCCC offers guidance to health care practitioners on HIV, hepatitis, and substance use. Dr Chu and Dr Pollock discuss the most common questions asked by clinicians to the NCCC warm line such as: infant feeding by people with HIV, antiretroviral treatment (ART) for pregnant people with HIV, and the use of long-acting antiretroviral drugs. They also discuss how they respond to questions about the latest developments in preexposure prophylaxis (PrEP) care, care for people with sexually transmitted infections (STIs), and health care practitioner exposures. Finally, they share their thoughts about working for the NCCC and the service they offer to US-based clinicians.

0:00 – Introduction

1:31 – History and overview of the services provided by the NCCC

4:31 – A common question – infant feeding in people with HIV

10:03 – ART for pregnant people with HIV

13:53 – Questions about long-acting antiretroviral drugs

16:55 – Interpretation of resistance-associated mutations

18:30 – The NCCC warm line service model

20:34 – Questions about administering PrEP and impact of recent developments in PrEP research

26:08 – Questions about postexposure prophylaxis (PEP) for STIs

27:25 – Recommendations for health care practitioner exposures

29:17 – Final thoughts and closing remarks

Resources:

Contact the National Clinician Consultation Center (NCCC):

https://nccc.ucsf.edu/

__________________________________________________

Produced by IAS-USA, Going anti–Viral is a podcast for clinicians involved in research and care in HIV, its complications, and other viral infections. This podcast is intended as a technical source of information for specialists in this field, but anyone listening will enjoy learning more about the state of modern medicine around viral infections.

Going anti-Viral’s host is Dr Michael Saag, a physician, prominent HIV researcher at the University of Alabama at Birmingham, and volunteer IAS–USA board member. In most episodes, Dr Saag interviews an expert in infectious diseases or emerging pandemics about their area of specialty and current developments in the field. Other episodes are drawn from the IAS–USA vast catalogue of panel discussions, Dialogues, and other audio from various meetings and conferences.

Email podcast@iasusa.org to send feedback, show suggestions, or questions to be answered on a later episode.

Follow Going anti-Viral on:
Apple Podcasts
YouTube
X
Facebook
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...