World AIDS Day 2018: Hadassah Doctor Searches for a Cure
Dr. Hila Elinav, is the Director of the AIDS Center in the Department of Clinical Microbiology and Infectious Diseases at Hadassah Medical Organization.
Dr. Elinav graduated from Hebrew University in Jerusalem with a B. Sc in Medical Sciences and received her MD from Hebrew University Hadassah School of Medicine. All her postdoctoral training was at Hadassah Hospitals. In 2003, she was appointed as an instructor at the medical school. or the three years prior to her appointment as the Director of the AIDS Center, Dr. Elinav was a research fellow at Yale University in Connecticut. She is the recipient of various academic awards and a research grant.
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Melanie Cole (Host): Globally there are more than 36 million people living with HIV worldwide. This year marks the 30th anniversary of World AIDS Day. Wow time goes fast, and if you're of a certain age you know that in 1988 the World Summit of Ministers of Health started their program for AIDS prevention. Today we're speaking with Dr. Hila Elinav on this episode of Hadassah on call.
Welcome, my guest today is Dr. Hila Elinav. She is the Director of the AIDS Center in the Department of Clinical Microbiology and Infectious Diseases at Hadassah Medical Organization. Dr. Elinav, tell us a little bit about yourself and how you came to Hadassah Organization.
Dr. Hila Elinav (Guest): Well I was born in a small village in the south of Israel and after my military service, I went to medical school in Hadassah. Actually all my medical career was in Hadassah except three years that I was doing research fellow at Yale University in Connecticut and when I came back from Connecticut, I was appointed as the Director of the AIDS Center in my hospital, in Hadassah Medical Hospital. Ever since I'm there.
Host: Doctor, we hear so much less about HIV and AIDS these days. Is the epidemic over? Please tell us, what's going on in the world in regards to HIV and AIDS and improving the quality of life for people living with HIV?
Dr. Elinav: So unfortunately, the epidemic is not – didn't end yet. We're still working on it, but about 1.8 millions are diagnosed with HIV around the globe yearly and in Israel it's about 400 new cases diagnosed yearly. People still get infected. Some people are being diagnosed with real AIDS, with the disease when they have advanced disease, and there's a lot of things to do. Of course, the medications that are compromising the cocktail – they change dramatically the morbidity and mortality. People can live almost a normal lifespan and they need to be followed. There are side effects and there's a lot to do – still a lot to do even in prevention. We have new methods. We still use the old fashioned condoms but there are medications to prevent infections before exposure and after exposure, but you still have to do a lot of about diagnoses of new cases and this is our daily life.
Host: Doctor, recently the movie Bohemian Rhapsody came out about Queen star Freddy Mercury who tragically died of complications of pneumonia related AIDS. People thing AIDS isn't really around anymore, not very common. Can you speak about this and has the stigma reduced at all in the last 20 years, and have you seen the movie?
Dr. Elinav: Yes, of course I've seen the movie because I'm a big fan of Freddy Mercury and Queen but things changed a lot. When Freddy Mercury was infected actually there was very few medications that were available, they were very toxic, and they didn't work for a long time. They worked for two or three years and then the virus became resistant to the medication. In 1996, new medications came to the market with different mechanisms and this made a tremendous change because this way we can really suppress the virus and when you suppress the virus to what you call today undetectable levels, you reconstitute the immune system and you turn the wheels back. You can take very ill patients and then with treatment they become healthy. Actually today I had a case of a patient who I thought is going to die a month ago, and today he went home; so it's amazing what you can do. You can really take dying persons and make them alive and this is thanks to the cocktail – to the medications that we use that are combination of treatment. They are less toxic than what was used in the 1990s and it's really a new era.
Host: One of the themes, the main theme of this year's World's AIDS Day is knowing your status. How important is it to know your status, and what's the best way to test for HIV? And people are concerned about testing, Doctor, because of confidentiality and privacy. Is this an issue?
Dr. Elinav: Well stigma I think is still the most problematic thing in HIV medicine because people are afraid to be tested because they are afraid to be discovered as HIV and then they are afraid that there will disclosure to their family surrounding and this is a big issue, but it is very important because if you're known as HIV positive, you can be treated on time and actually prevent all the complications that will be in the future if you are not treated. You can – you will actually stay as a carrier and you will never get sick. Now there's another issue with knowing your status because if you are treated actually you are not infected if you are undetectable. The slogan today is You Equals You. Undetectable means untransmutable. Now because something in the last one or two years that we talk about and they look at their lives completely differently. They know that they can get married even to somebody that is HIV negative and this is not an issue anymore. Of course, we have to do a lot of work and speak with their partners but this is part of our daily life. Stigma is still I say the most problematic issue in HIV medicine.
Host: I would imagine that it is, and Doctor, we've heard that you went out of your way to save a baby who was delivered at Hadassah Hospital recently. Can you tell us about it and tell us your experience with noncompliant mothers that might be HIV positive but they're afraid to mention it because they don't want to have a C-section. Explain a little bit about why this is.
Dr. Elinav: Okay, first I will tell about the case. So this is a case of a new immigrant coming from Ethiopia. She was married to an Israeli but he was in Israel and she was in Ethiopia and she immigrated when she was in their eighth month of pregnancy and she never had pregnancy follow up in Israel and so when they came to the delivery room, the nurses asked the husband because she doesn't speak Hebrew, was she tested for HIV? And he said, yes she was and she is negative but he didn't know that the results were different from what he knew because the results were four years old when they were in Ethiopia. So actually she was infected somewhere in between and nobody knew and she delivered the baby. Now the nurses sends HIV test because it's the protocol but we found that she was HIV positive after the baby was delivered. So this was a critical time and when we found out that there's an HIV patient in the – that just delivered, we went to see her. She didn't know her status. She really didn't know and we asked her if she already started breastfeeding and she didn't fortunately, but what we did – we talked with her. We told her don't start to breastfeed, and then we – the pediatrician actually prescribed her medication to prevent the transmission of HIV to the baby because the most vulnerable time for the baby to be infected is during delivery. So they prescribed it and then I went home and then I decided to call to make sure that everything is fine and then I found out that these medications were not available in Hadassah because we hardly use them. Most of our women are treated during the pregnancy and what we give is only ABC to the baby and then we needed two other medications and I was fortunately around Tel Aviv and I called all my friends in the other AIDS Center in Tel Aviv and I found out the other two medications were in another pharmacy of one of the hospitals and I went there, brought the medication, and brought it to the baby and they gave it – we usually start medication immediately; it was 26 hours later, but it was not too late and we gave it to the baby and she's negative so I'm very happy with this.
Host: Wonderful story.
Dr. Elinav: Yeah, it's exceptional. We usually don't have these cases because we try to – most of the women in Israel are screened. It's not obligatory in Israel yet and we find women that were not diagnosed previously, we find them during pregnancy and then we start treatment like all the other patients and then the chances for a woman to transmit it to the baby are less than 1%, even without C-section, without IV, ABC, just normal delivery, she cannot breastfeed and we did ABC for the baby for four weeks and that's about it, and this is common. This is the most common. This case was exceptional, but sometimes we have some adrenaline in our blood.
Host: Wow I love to hear these kinds of stories and they're very inspiring. What do you feel, Doctor, are some of the major challenges that still remain, and are you seeing that young people are having the conversation about AIDS and HIV status?
Dr. Elinav: Actually since I work in the hospital and not in the community, I hardly meet those people. I know that the Israeli Task Force is doing a lot of talks in schools in Israel. You know I go from time to time to give a talk to young people, and so it's not only about HIV but also about the other sexually transmitted diseases and I'm always trying to stress that this is preventable. It is better to prevent, but if you're HIV positive, it's not the end of your life. When you're HIV positive, you should know that you should still dream and fulfill your dream and you'll have normal life, you just have to take care of yourself better. It's always better to prevent, but it's not a disaster if you're HIV positive. It's more difficult, yes, but life is difficult.
Host: So as we approach World AIDS Day, this Shabbat, December 1st, what message do you have? Tell us a little bit about the goal of this awareness campaign and summarize this episode for us. What would you like the listeners to take away from this, Dr. Elinav?
Dr. Elinav: Well my first message is that everybody should be tested and for the medical stuff I always stress that you know you should not stigmatize the patient. If you think that something might be compatible with HIV, it doesn't matter if this is a religious person or somebody from the Arab community, always test people for HIV and don't be judgmental, so I just try to encourage people to check their status, and you know you can never know and it's not very important how people got infected. When they are infected, you should always stress that here is a good prognosis and there is always bright future, and this is something – it's a chronic disease that is much, it's very easy to treat. You just need to be compliant, and this is a different era really. Nobody would imagine 30 years ago that people will live for 60 years after they're being infected, that they can have babies, they can get married with HIV negative people, and I think that somewhere in the future we will have a cure. I'm very optimistic about it because a lot of effort is done in this direction and I hope that even before I retire I can cure my patients. Actually since I can help so many people with HIV or to prevent HIV, I feel that I do a lot and really this is what makes me love my work. I wake up every morning enthusiastic to go to the clinic and to go to the hospital, and I just love my work.
Host: Wow you know it's such an interesting topic and to hear about it so many years later is, for certain people, of my age group, Doctor, you know we heard about this so much growing up but then not so much anymore and I applaud your efforts and your stories and thank you so much for all the work that you're doing and for the awareness campaigns and World AIDS Day is December 1st, coming up this 2018 so thank you so much for joining us and sharing all of your information and your hope for a future cure because that is really very exciting to hear. This is Hadassah On Call, new frontiers in medicine brought to you by Hadassah, the Women Zionist Organization of America. The largest Jewish women's organization in American, Hadassah enhances the health of people worldwide through medication education, care and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine, please visit Hadassah.org, and to hear more episodes in this podcast series, please visit Hadassah.org/podcasts, that's Hadassah.org/podcasts. I'm Melanie Cole, thanks so much for joining us today.
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