Dr. Paul Bellman, a physician in private practice in Manhattan, has treated many HIV/AIDS patients over the past 25 years. As a medical student at NYU Medical School in 1980, he was involved in the care of the very first AIDS patients, then diagnosed with what was called GRID or Gay-Related Immune Deficiency. Bellman was formerly an attending physician at Saint Vincent's Hospital in New York, and is now affiliated with New York Presbyterian Hospital.
Question: How effective are antiretroviral drugs at making people with HIV non-infectious?
Paul Bellman: I think one of the critical issues facing HIV positive patients today in terms of their quality of life and also one of the critical issues in terms of creating the atmosphere that would be conducive to people being more willing to get tested and treated is the potential for the idea that some people who are HIV are not infectious. That could really be very liberating in terms of the whole community whether individual patients are non-infectious or not.
About two years ago a very prominent Swiss doctor, Dr. Bernard Herschel, chaired a committee that was sponsored by the Swiss government to determine whether or not what we called discordant couples where one partner is positive and the other partner is negative what the risks really were in terms of transmitting HIV. And particularly in an era where we could treat patients effectively, the question that they were addressing very specifically was whether or not someone, an HIV positive individual who is on effective treatment and had a very low undetectable viral load and as defined by Dr. Herschel for over six months, could transmit HIV to their negative partner whether or not they were practicing safe sex, which, you know, is the current standard in terms of HIV prevention between discordant couples and absolutely needs to continue to be so.
But this was an important question to address and their conclusion after looking at a series of scientific studies that were done just to track what happened to discordant couples and test the negative partner frequently is they couldn’t find any negative people who were turning positive even when the couples were acknowledging that they weren’t practicing safe sex. So that led Dr. Herschel to conclude that... to at least put forth a hypothesis that effectively treated patients might indeed be noninfectious and that created a lot of controversy and it also created some concern that, if misunderstood, it could lead people to relax safe sex precautions and that the paradoxical result could be more rather than less infections.
And the Center for Disease Control, which plays a very important role in public health policy in this country and gives great deal of considerations to all of its policy decisions basically said that yes, you know, reducing the viral load definitely reduces the infectious rate, but at this point you know we insist that people still follow and practice strict safe sex precautions.
Recorded August 18, 2010
Interviewed by Max Miller