SPEAKER_00: 0:01

Welcome to the Healthy Matters Podcast with Dr. David Hilden, primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health, health care, and what matters to you. And now here's our host, Dr. David Hilden.

SPEAKER_03: 0:19

Hey everybody, welcome to episode 8 of season 5 of the Healthy Matters Podcast. I am your host, David Hilden. You know, HIV is something that seems to come in and out of our public discourse every now and then. And it's a disease that for many people still carries a lot of fear and rather outdated thinking, to be honest. But in 2026, it's actually very different from what most of us remember from the headlines decades ago. To help us understand just how far we've come and where we still need to go, I'm joined by Dr. Amanda Noska. She is an infectious disease physician at Hennepin Healthcare in Minneapolis, and she knows quite a bit about the topic. She is the medical director of our Positive Care Center, which is the clinic where people living with HIV come to get care. Amanda, welcome to the podcast.

SPEAKER_02: 1:04

Thanks for having me.

SPEAKER_03: 1:05

Could we take a brief look back to start out about the history, a little bit of HIV? I do remember being in high school and we were learning about a new thing, a brand new thing. It was called HIV. None of us had ever heard of it before. So many of us do remember those early days of the 80s and 90s. It was a time of fear, kind of a time of stigma, and you know, very limited treatment options. Could you lay the groundwork for our listeners, especially for those who maybe weren't around then, and maybe paint a quick picture of what HIV care looked like and what what it was like in those early years?

SPEAKER_02: 1:36

Yeah, sure. HIV in the early 80s, it was first described in 81, was at the time that it was identified a terrifying thing, really shook the whole world. And it took quite a while to figure out the name of the virus, what it did to the body, and we didn't have effective treatments for for quite a while. So there was um a period of many, many years where people were living with a death sentence, what they can perceived to be a death sentence and what frequently was, and perhaps worse, a life that was really, really terrifying and full of medical illness. I think there wasn't a ton of hope at the beginning of the HIV epidemic, and people felt incredibly scared. There was a lot of terror kind of shaking the medical community, and socially it was an absolute death sentence as well, because people were terrified of anyone that might be living with HIV.

SPEAKER_03: 2:31

Yeah, you were people were afraid of those who had HIV. It was so stigmatizing at that time.

SPEAKER_02: 2:36

Yeah.

SPEAKER_03: 2:36

They made movies about it, and you know, that you talked about the people who got HIV and why did they get it, and and it was such a terrifying time. And there wasn't much to be done about it at that time, was there?

SPEAKER_02: 2:47

No. That we didn't have effective treatments, we didn't have any any opportunities. We didn't even know what it did to the body or how it was transmitted for at least a couple years before the transmission was only described two years after it was identified, and the effective treatments didn't come for uh five or six years into the epidemic.

SPEAKER_03: 3:06

So we're talking over half a decade, two years before we even knew how you got it from one person to the next, or well, how you got it. And then another five years before there was anything really to be done about it.

SPEAKER_02: 3:16

Yeah.

SPEAKER_03: 3:17

What changed?

SPEAKER_02: 3:18

Science. Science changed everything, right? I mean, we had brilliant people working on this in a concerted way and ended up discovering the virus, what it does, how it's transmitted, and that as the HIV virus infects the body, it can suppress the T cell immune system. And then they figured out how it does that so that they could treat it, right? So we figured out how to treat it based on how it targets the CD4 cells or the T cell immune system. And that was the game changer of all game changers.

SPEAKER_03: 3:51

That was the game changer. And then some some effective medications came along. I remember AZT. Was that the first one? That was. Um, as being this miracle thing that, oh my goodness, there is something to be done. And it was a palpable change in our collective consciousness. Although we still had a long way to go. It wasn't like everything was great five or eight years after the disease was first described. You you touched a teeny bit on uh C D cells and immune systems. Could you give us a how do and how does an immune-mediated disease work? How does HIV work in a bad way?

SPEAKER_02: 4:26

Yeah. I'm no immunologist. We have brilliant immunologists here, including some of my colleagues. But the immune system is comprised of three major immune kinds of groups. There's B cells, which are humoral immunity, T cells, which are cellular immunity, and an innate immune system, which is a 30-day kind of sneak and attack immune system when you have an invader in the body. And the cellular immune system is comprised primarily of T cells. T cells protect you from viruses and fungi. And T cells, the sort of conductor of the orchestra for the cellular immune system is the CD4 cell. And that, unfortunately, is the one that HIV targets and damages. And the T cells also help to coordinate those other two immune systems I was talking about. So it's it's a really vital cell to the entire immune system function.

SPEAKER_03: 5:16

And when that one goes, when that cell gets attacked, your immune system goes wacky and all kinds of things happen. Could you clarify what's the difference between HIV and AIDS?

SPEAKER_02: 5:26

Yeah, great question. So HIV is an infection from the virus that isn't associated with as severe immune compromise. AIDS is comprised uh or defined rather by either a CD4 cell count of less than 200, which is a marker for really severe immune suppression, or an infection that signals really severe immune infection. And that's there's a laundry list of those conditions. But it's one of the two things that defines AIDS, which really just means very severe immune suppression.

SPEAKER_03: 6:00

Yeah. And AIDS, for listeners who don't know, stands for acquired immune deficiency syndrome. Am I right on that? I haven't even thought about that for a while.

SPEAKER_02: 6:08

You nailed it. Good job.

SPEAKER_03: 6:09

Okay, so before we dive deeper, and we are going to, when people hear HIV today, what do you think most of them still get wrong?

SPEAKER_02: 6:16

I think it depends upon who hears it. But I think that some folks, I hate to be too general here, are still very worried that it's a death sentence or that it will significantly harm them, impair their health, or impair their ability to live a free and easy life.

SPEAKER_03: 6:36

Is it a death sentence now?

SPEAKER_02: 6:38

Absolutely not.

SPEAKER_03: 6:39

Yeah. I think that that is what we're gonna talk about a bit later is that there are old folks walking around with the and they they you know they maybe wouldn't have been in the 80s, they are today. And we are gonna we are gonna talk about that's the norm, actually. It's not a death sentence.

SPEAKER_02: 6:54

Yeah, that's right. I oftentimes use metaphors um in speaking with patients. And one of the things that we talk about is it being more like living with high blood pressure than living with a metastatic cancer. It's a really different disease, thanks to science and and scientific progress.

SPEAKER_03: 7:10

I I second that. Okay, let's talk numbers just for a little bit. We're not gonna talk too many numbers, but a few here. Where are we today? It hasn't disappeared, but it's much more nuanced than you know, perhaps uh many people realize. So, roughly how many people are living with HIV in the United States today?

SPEAKER_02: 7:25

Yeah, there's 1.2 million roughly. Um the numbers are a couple years old, but 1.2 million people in the U.S.

SPEAKER_03: 7:31

So significant number. That sounds like a large number.

SPEAKER_02: 7:34

It is.

SPEAKER_03: 7:35

How about new cases?

SPEAKER_02: 7:36

We still struggle with new cases. There's about 30, 31,800 um as of 2022.

SPEAKER_03: 7:44

31,000 new cases per year. Per year. As of a few years ago.

SPEAKER_02: 7:49

Per year.

SPEAKER_03: 7:50

Okay. And then kind of a sadder number, um, people still do die from HIV. Well, how's that going? What are the trends in deaths from HIV?

SPEAKER_02: 7:58

About 19,000 people per year die of HIV associated causes. That number is pretty dramatically decreased. I I have some numbers here, but the mortality was much, much, much higher. It decreased in 1997 after the advent of antiretroviral therapy by 47%. Wow.

SPEAKER_03: 8:18

Wow. So we're going to talk about what an antiretroviral therapy is, ART. Those are the drugs or the medications, maybe I should say. While we're still on kind of the numbers and demographics, what populations or regions of the world are at most risk?

SPEAKER_02: 8:35

What we're seeing right now, I think, is uh largely an incidence or new HIV diagnoses happening among folks who are marginalized in the world for one reason or another. The South sadly is very disproportionately affected by new cases of HIV, in particular young individuals and in particular folks who are black or Hispanic.

SPEAKER_03: 8:57

That's in this country.

SPEAKER_02: 8:58

That's in this country. Trevor Burrus, Jr.

SPEAKER_03: 8:59

People who are of a certain age, like me, maybe, um, do recall that at the beginning it was men who had sex with men. That was the main, that's all you heard about. That's what part of the stigmatizing thing was about back then, to be honest. Uh, how is that population doing?

SPEAKER_02: 9:14

Aaron Powell Men who have sex with men are still um disproportionately affected, and the largest at-risk group for HIV and that incidence or the new rates of HIV have s is still rising. It rose about six percent over the last five years.

SPEAKER_03: 9:29

Okay, so we still have work to do.

SPEAKER_02: 9:31

It's still a big problem. Um, but we're seeing a much larger rise among heterosexual men and women, especially men and women of color.

SPEAKER_03: 9:39

Why is that, do you think?

SPEAKER_02: 9:41

That is a really complex answer. Um, but I think it's uh related to healthcare access and a lot of social determinants of health and structural inequities, especially in the South. I think folks have a hard time getting access to diagnosis. There's a a minority of folks who are living with HIV and and unaware of it. And that is a very risky situation. One incredibly heartening thing about the human race is that when people know that they have the infection, the m vast majority change their behavior to protect other people from getting the infection. But if you're undiagnosed, you can't protect anybody because you don't know.

SPEAKER_03: 10:23

Yeah.

SPEAKER_02: 10:23

So yeah, there's a larger proportion that are undiagnosed when they are not able to or don't feel comfortable getting healthcare access. And honestly, we have some work to do with the medical community to make it more accessible to folks who have some challenges with interfacing with the healthcare system in its traditional format. I think that trauma-informed patient-centered care is still very vital to our patients more now than ever. And I think that is a very big limiting factor. And then the other, I think, very big part of it is that in the South, at least, folks who are unhoused or who have other social determinants of health can't prioritize their health because they have so many other things going on. So it's very hard to think about your health when you don't know where you're gonna sleep tonight or what what you're gonna eat.

SPEAKER_03: 11:13

I'm really glad you brought that up. Good points, good points. Let's talk now a little bit about at the individual level, how people get HIV. Um, sort of the basics of how it's transmitted. Could you tell us that?

SPEAKER_02: 11:25

Yeah, HIV is predominantly transmitted through exposure to either blood or through sexual practices. And so it can be transmitted sexually, or it can be transmitted through sharing of drug works, or it can also be transmitted vertically, which means babies can be born to parents with HIV.

SPEAKER_03: 11:46

Is that consistent over since the 80s? Has that always been the case, or is there a mode of transmission that is growing in prevalence versus the others?

SPEAKER_02: 11:55

Again, it's really a beautiful thing that we have been able to reduce mother-to-child transmission of HIV very dramatically since 1988. We've had IV treatments to reduce uh mother-to-child transmission. And just using antiviral therapy for moms who are pregnant with detectable virus reduced the mortality of HIV from 26 to 5%. So that just works. So that was a big game changer. And the transmission from mother to child is less than 1% these days. It's very hard to do rigorous trials because it's so effective. The antiviral therapy is so effective.

SPEAKER_03: 12:32

It just works. It should be done.

SPEAKER_02: 12:33

It is really phenomenally effective. And then the other things that have really the transmission has dramatically decreased for those on treatment because our treatments work really well. And when you have an undetectable virus, you cannot transmit HIV sexually, even if it's condomless sex, if the viral load is less than 200 or um, we call it, we say undetectable, which is for our lab at least less than 48. But anything that's undetectable is untransmittable, which means you cannot transmit the virus living with HIV sexually if you're on good effective treatment and it's working well.

SPEAKER_03: 13:08

I was gonna ask you about undetectable equals untransmittable. Do you do that message in your clinic at the positive care center at Hemic? Do you tell patients that?

SPEAKER_02: 13:16

Yeah. Yeah. Routinely. It's a really life-changing thing for many of our patients who are well-meaning and doing the best that they can, living with the disease. And it's really liberating. It helps people to feel You're undetectable. Yeah, that they're not gonna harm somebody and that they can live a semi-normal life, right? They they acknowledge they have the disease, but they don't have to worry about it every day, all day.

SPEAKER_03: 13:42

Yeah, that is so liberating and so important. Again, thanks. Thank you, science. And thank you for the people like you who are doing that work. In your practice, are you hearing myths from people or misconceptions maybe in the community of that you serve or in the population in general about how it's transmitted? Is there anything people need to know that no, no, no, no, that's not how it is. Are you hearing anything like that?

SPEAKER_02: 14:05

Yeah, unfortunately, we still are. There are a lot of myths out there. We still hear people fearing that they could acquire HIV from saliva or sharing a cup or hugging their loved one or sharing a toilet seat, which is absolutely not the case. And that's unfortunate. And then I think I have also heard some theories about HIV transmission, intentional HIV transmission, but I I can't really speak to those, but my patients sometimes bring those to me and that they're worried about that.

SPEAKER_03: 14:34

Yeah. But you did say earlier when the vast majority of people, once they know they have they carry this virus, take steps to protect others. Yeah. Most people do that. That's reassuring to know.

SPEAKER_02: 14:45

Yeah.

SPEAKER_03: 14:46

So we gotta test folks and get people into care, it sounds like to me.

SPEAKER_02: 14:49

That's right.

SPEAKER_03: 14:50

Okay, we are getting up to speed on the current state of HIV with infectious disease physician Dr. Amanda Noska from Hennepin Healthcare. After a quick break, we're gonna discuss treatment, living with HIV in 2026, as well as what's on the horizon for HIV care. Stay with us, we'll be right back.

SPEAKER_01: 15:08

When Hennepin Healthcare says, We're here for life, they mean here for you, your life, and all that it brings. Hennepin Healthcare as a hospital, HCMC, a network of clinics in the metro area, and an integrative health clinic in downtown Minneapolis. They provide all of the primary and specialty care you'd expect to find, as well as services like acupuncture and chiropractic care. Learn more at Hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

SPEAKER_03: 15:44

And we're back talking about HIV care. So let's get into treatment, Amanda, if we could. Because that's where the biggest transformation I think has happened over the last several years or or even decades. So if someone's diagnosed with HIV today, what does treatment look like?

SPEAKER_02: 16:00

We have really made incredible progress over the last 40 years. We now have same or next day antiviral initiation, anti-retroviral initiation. ART, we call it.

SPEAKER_03: 16:11

Yeah, so when you hear ART, listeners, it stands for anti-retroviral. Can I just like um back up a step? What why is it called that? What's retroviral?

SPEAKER_02: 16:19

HIV is um very 50s. Is technically a retrovirus, right? So the way that it replicates kind of is in the name. And the antiretroviral treatments we use just describe exactly the mechanism that of action of the drug to the virus.

SPEAKER_03: 16:35

So we have good antiretrovirals. Sorry for interrupting there. Okay, go ahead.

SPEAKER_02: 16:39

Um, so same or next day, anti- uh retroviral treatment is the standard of care these days, which means that for folks that are newly diagnosed with HIV, we want them not to have to live with that knowing for any amount of time before starting treatment. And that's a beautiful thing. And we're fortunate to be able to pull that off regularly in our clinic and in this community. And that's a really important thing as well for health. It helps to reduce something called the reservoir, which is the amount of virus that's in the cells in a person's body. And the reservoir is a really important thing to be paying attention to as an HIV provider because it is responsible for ongoing inflammation in the body. We all know that's a dirty word, inflammation. And inflammation in the body can contribute to kind of long-term risks for cancer, heart disease, and other things that are secondary consequences of HIV. So same-day treatment helps to avoid those risks for the rest of a person's life or next day treatment. The sooner people start treatment, the safer they are from those consequences of disease.

SPEAKER_03: 17:51

You're talking you they get their positive blood tests and you start it then.

SPEAKER_02: 17:56

That day or the next day. Yep, as soon as possible.

SPEAKER_03: 17:59

Yeah, that's new to me. I didn't even know you did that.

SPEAKER_02: 18:01

Yeah.

SPEAKER_03: 18:02

Right away.

SPEAKER_02: 18:02

Yeah.

SPEAKER_03: 18:03

So that inflammation thing you were talking about, that is just the presence of the virus in the body. Before we hear about opportunistic infections and all the big bad life-threatening complications that are fortunately not as common anymore, but still happen.

SPEAKER_02: 18:18

Yeah.

SPEAKER_03: 18:18

You're just talking about the presence of the virus leads to that stuff.

SPEAKER_02: 18:21

That's right. Yep. And treatment helps to reduce that risk to an all-time minimum.

SPEAKER_03: 18:26

What's the downside of having that inflammation caused by HIV in your body? You said it has cardiovascular effects.

SPEAKER_02: 18:32

Yeah.

SPEAKER_03: 18:32

What do you mean?

SPEAKER_02: 18:33

So the the biggest downsides to having more inflammation in the body is that you'll have a lot of other medical, we call them comorbidities, which is a fancy word for other diseases. Well, maybe I should start saying that. Other diseases. So HIV and heart disease are very, very common to see together. HIV and high cholesterol are very common to see together. HIV and cancers, age-linked cancers or virus-linked cancers, are more common among folks living with HIV. And that is predominantly driven by sometimes other viruses in the body. But aside from that, it's all reservoir that that virus in the body and the ongoing inflammation from the presence of the virus in the body.

SPEAKER_03: 19:18

I'm going to talk about the treatments itself, what they look like. Because I remember when AZT was invented, it was a pill. And then so patients took this one pill, and then more pills got developed, and more pills got developed. And eventually people living with HIV were taking handfuls of pills. This must have been in the 90s, probably. Is it still like that? What are what is the pill regimen? Or what I'm getting at is not all pills anymore, is it?

SPEAKER_02: 19:44

Right. Yeah. Yeah. You're getting at it. The pills that folks used to take had really, really horrendous side effects, pretty reliably. So oftentimes there uh folks would call the treatments worse than the disease. It was terrible. It was awful, wasn't it? The side effects were. In faces. You would see that in their faces. Yeah. And that's why they're watching their loved ones and friends die of AIDS. So it was a really traumatic time that many of my patients have lived through. But the new treatments are one pill once a day. Most people can get those unless they have really severe resistance patterns. And the treatments are universally effective.

SPEAKER_03: 20:38

One pill once a day.

SPEAKER_02: 20:39

Wildly effective with very limited side effects for most people. Not all. Some people still have some severe side effects, but most people don't. Most people live with very few side effects, take one pill once a day, and have an undetectable virus.

SPEAKER_03: 20:54

That's incredible. What about injectables? Now that is something that's even newer.

SPEAKER_02: 20:58

Yeah. 2021 is when injectables hit the scene and they have really revolutionized healthcare delivery in a patient-centered fashion. So stigma has been one of the biggest game changers with HIV. When folks can get treatment through an injection and not have to take pills every day, they're not reminded every day that they're living with HIV. They can keep doing their business, know they're keeping themselves and others safe. And the biggest side effect is some buttock pain because that's where they're injected. And we have really amazing nurses in clinic who know their stuff. And they teach our patients how to do their leg lifts and exercises to reduce those side effects.

SPEAKER_03: 21:39

Get the blood moving, get the muscles moving. So do people do them in the clinic or are the injections done at home? That's question one. And how often?

SPEAKER_02: 21:46

They're done in the clinic right now, but they are exploring scientifically whether or not people are able to get them at home or have like a long term delivery system in the body, whether it be some kind of implant, their implants being Being studied or bead of some sort. And so that's actively under investigation.

SPEAKER_03: 22:07

Because we do that for other medications. There are birth control medications that get implanted and it just leaches into your system over months or years.

SPEAKER_02: 22:15

Yeah, it's possible. The injections work in that fashion through a nanoparticle technology. And it's really, really beautiful because you only have to get the injections for most people every two months. Also, that isn't so bad. No.

SPEAKER_03: 22:28

They come into your clinic or the clinics wherever they're getting care. Every couple months get a shot in their in their derriere, have a little sore bottom, but then they can go live their life. And I like that that you said that you don't have to remember every day that you're living with this disease by taking this medication.

SPEAKER_02: 22:43

Yeah, that's what my patients tell me, right? And it's I don't elicit that. They tell me that it's it's really uniform that a lot of folks feel a la a loss of stigma, even if they weren't aware of it before they switched to injections. They become aware of it after they've switched over.

SPEAKER_03: 22:59

Side effects of the injections, is it similar to that once-a-day pill, which is minimal, or are there more?

SPEAKER_02: 23:04

Yeah, aside from the buttock pain, there's probably fewer side effects to the injections in some ways. The nausea, vomiting, and diarrhea that we counsel patients about for the first few days of taking antiviral tablets are less common with injectables. And there is some risk of maybe a flushing syndrome with one of the medications that's in the injection or headaches, but that's very, very uncommon.

SPEAKER_03: 23:27

Okay, so if people get early care same day, next day starting, and they get into a place when get consistent access to care, what does life expectancy look like now?

SPEAKER_02: 23:37

It's the same as the general population. Get out. With a couple of disclaimers. We want folks to have complete immune recovery, which means that those T cells we were talking about, the CD4 cells, are over 500. But when people have that, they have a normal life expectancy of 87 years.

SPEAKER_03: 23:54

As long as your T your T cells, your C D4 cells get above 500.

SPEAKER_02: 23:57

Yep. And that's a vast majority of folks, or or the majority at least, of folks who living with HIV.

SPEAKER_03: 24:03

That might be the most for those of you who are of an age to remember the 80s.

SPEAKER_02: 24:07

Yeah.

SPEAKER_03: 24:08

To hear an infectious disease doctor right here in 2026 say that life expectancy, it's possible to be normal. And in fact, for most people on treatment, it is a normal life expansion. That's just astonishing to guys like me, and I bet many people listening today. So I imagine then people living with HIV well into their 70s and 80s and longer are dying of the same things that everybody else is. That's right. Yep.

SPEAKER_02: 24:34

Heart disease, cancers.

SPEAKER_03: 24:35

So so take care of those things too. Don't forget that.

SPEAKER_02: 24:39

Yeah. That's a big focus in our clinic. We do primary care for folks living with HIV for that very reason.

SPEAKER_03: 24:45

We call your clinic one of our primary care clinics. Yeah. Even though it's an infectious disease clinic, primarily, not exclusively, but largely sees people living with HIV. It is a primary care practice. You are their main doctors.

SPEAKER_02: 24:57

Yeah, we see folks there for all kinds of different issues outside of HIV, but we're really honored to do that.

SPEAKER_03: 25:02

Somebody told me and uh that our positive care clinic at Hennepin Healthcare in downtown Minneapolis sees not quite half, but a third or 40% of the patients living with HIV in the state. Is that a true statement?

SPEAKER_02: 25:15

I don't know the actual percentage, but I know we care for over 3,100 people living with HIV.

SPEAKER_03: 25:20

So it's a lot of the people. Just a quick uh a quick plug for that clinic. It is one of ours that gets the highest patient satisfaction scores. It's one of the most scientifically and human-centered clinics I've ever seen. And it's the one that you direct. So thanks for that. Could you explain to our listeners what PrEP is?

SPEAKER_02: 25:38

Yeah. Pre-exposure prophylaxis, we call PrEP. Pre-exposure prophylaxis is a fancy word for preventing HIV. And there's lots of different options for that. And I'm fortunate to work with some extremely talented experts in that realm, as colleagues of mine. It is either a pill or an injection that is taken at some frequency to prevent HIV. It could be daily pills. It could be this mechanism we call 211, which is two pills before sex, the day before sex, and then one pill after for two days. Or it could be an injection that people get every two months or every six months, depending upon the injection of they choose. There are two different options. Both of the injectable options are really, really effective. There were these really amazing trials that have just been published called the Purpose Trials, showing that a drug called Lenacapivir is a hundred percent effective at preventing HIV when you receive it once every six months.

SPEAKER_03: 26:38

Wow. Once every six months.

SPEAKER_02: 26:40

I mean, you can't get better than that.

SPEAKER_03: 26:42

Okay, so I'm glad we touched on that a little bit because that is an important thing for people who now that is for people who are not diagnosed with HIV.

SPEAKER_02: 26:49

Yeah, that's right.

SPEAKER_03: 26:50

But have some something in their life that puts them at risk for getting it, like their sexual partner, right?

SPEAKER_02: 26:54

Yeah. Sexual partner, drug use, a partner living with HIV, lots of different risk factors out there, some unknown risk factors. Sometimes people worry about having a risk factor from sexual partners not disclosing their status. It's mostly a protection.

SPEAKER_03: 27:10

Okay, man, if I have you back on the podcast in 10 years, what do you hope has changed?

SPEAKER_02: 27:15

I'm so excited about the field of HIV and the revolutionary science that has happened over the last 40 years to develop where we are today. But I think that in 10 years, I'm hoping we're staring down the barrel of a cure. I've been told at uh well, I've been I've heard at our um people say international conferences that uh it's possible within the next 10 years or so. It's possible. Um and that's pretty optimistic. But we have these really amazing technologies coming, monoclonal antibodies against HIV that are wiping out the reservoir that we've been talking about, which is the kind of areas in the body that HIV is residing that's making cure more difficult. There's really amazing HIV vaccine work that has been done for years and years. That's a very challenging field for our scientists. And then these treatments. So treatment as prevention and treatment as a mechanism towards cure of HIV has made just unbelievable progress. So I think uh in 10 years, I hope we're continuing to be much farther along with that. And I absolutely think that's possible. And I also think we have a lot of work to do with the other things, right? The homelessness, the social determinants of health that just prevent, it's very basic, but prevent our people from getting access to that. So I hope that we'll continue to care about that and to nurture that as well as we make these scientific advancements.

SPEAKER_03: 28:44

So mark your calendar for 2036. We're gonna get you back on the show and we're gonna see how things panned out. That is a hopeful um prognosis, in my opinion. Okay, before I let you go, one thing that you'd leave our listeners with that you wish they'd know.

SPEAKER_02: 28:57

I really think that it is absolutely exceptionally exciting to think about the progress that our scientific community has made with HIV. And I want to leave our listeners with hope and an understanding that that hope is intrinsically linked to our scientific advancements in our society and in science. So the hope that we bring to people every single day in the clinic is such a privilege and an honor that I can take very little credit for, having not done the rigorous scientific trials for antiviral therapy. But hope is intrinsically linked to those treatment trials that led to these injectable treatments and led to us, all these amazing scientific advancements brought hope to our society and have reduced the mortality rates so dramatically. So I think keep hoping and believe in those scientists who are doing that brilliant work with the field of HIV. And thank you to all of them for the tireless efforts that they've made.

SPEAKER_03: 29:58

I could not have said that any better. So HIV is it's such a powerful example of what's possible when science and advocacy and compassionate care come together. Dr. Noska, thank you for being here today.

SPEAKER_02: 30:10

Thank you for having me. It's been a privilege.

SPEAKER_03: 30:12

And thank you all for listening to the Healthy Matters Podcast. If you found this episode helpful, share it, please, with someone who might still be carrying outdated ideas about HIV. You know, because accurate information is a difference maker, and one of the big reasons that we do this podcast. Thank you to Dr. Noska. Thank you for listening. We will be back in two weeks' time with another great topic. And in the meantime, be healthy and be well.

SPEAKER_00: 30:35

Thanks for listening to the Healthy Matters Podcast with Dr. David Hilden. To find out more about the Healthy Matters Podcast or browse the archive, visit healthy matters.org. Got a question or a comment for the show? Email us at healthymatters at hcmed.org. Or call 612-873-TALK. There's also a link in the show notes. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas at Highball. Executive producers are Jonathan Comito and Christine Hill. Please remember we can only give general medical advice during this program. And every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.