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.

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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:
Apple Podcasts
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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
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Facebook
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...

In this episode of Going anti-Viral, Dr Michael Saag speaks with Dr Sandra Springer from the Yale School of Medicine about the substance use disorder epidemic. Dr Springer describes the history of the epidemic and the recent crisis of overdose deaths in the United States. She talks about the increase in overdose deaths since 1999 due to prescription opioids. Dr Saag and Dr Springer review how HIV practitioners can manage patients with substance abuse disorder, including a discussion of how to manage patients undergoing withdrawal. Finally, they address harm reduction strategies available to practitioners and new data showing a reduction in overdose deaths, providing long-term hope for the effectiveness of these strategies. But they note that more research, funding, and outreach is needed to meet the risks that opioid and non-opioid substances pose in the future.

0:00 – Introduction

1:22 – Magnitude of the substance use disorder epidemic

2:31 – Factors that led to the increase in deaths after 1999

3:54 – Background on widespread fentanyl use

5:22 – Impact of prescription opioids for chronic pain management on addictions

7:52 – HIV healthcare practitioners’ role in managing patients with substance use disorders

10:15 – Management of withdrawal, including long-term management options

18:33 – Harm reduction strategies and the use of naloxone to prevent overdose deaths

23:04 – Review of new data showing reduction in overdose deaths in the United States

24:19 – Closing remarks and expectations for the next 10 years

IAS–USA resources on substance use disorders:

-- MATE Act CME - https://www.iasusa.org/dea-compliant-cme-resource-center/

-- Fellow Resources: https://www.iasusa.org/fellow-student-resources/

__________________________________________________

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
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X
Facebook
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...

In this episode of Going anti-Viral, Dr Michael Saag speaks with Dr Andrew Pavia from the University of Utah about influenza A, specifically the H5N1 strain. Dr Pavia describes the progression of H5N1 and its recent impacts on poultry and other animal populations, including an overview of a recent outbreak among dairy cattle and whether there is a risk to humans exposed on farms and the milk supply at large. They discuss how influenza vaccines are determined each year and the timing of when best to recommend vaccination. They describe treatment options for influenza and their effectiveness against H5N1. Finally, they address public health measures taken during influenza outbreaks and the COVID-19 pandemic, offering lessons learned for future influenza outbreaks in humans.

0:00 – Introduction

1:32 – Overview of influenza

2:54 – Human susceptibility to influenza

5:20 –Types of influenza and evolution of H5N1 from birds to mammals

9:24 – Natural history of transmission in humans

12:34 – Current outbreak of H5N1 in dairy cattle and risk to the milk supply

16:48 – Overview of influenza vaccines and immunity

18:47 – Optimal time to get the influenza vaccine and combined vaccination for COVID-19

23:36 – Treatment options with onset of influenza symptoms and H5N1 is resistance

30:00 – Lessons learned from public health measures taken to protect against outbreaks of influenza and COVID-19

__________________________________________________

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
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...

In this episode of Going anti-Viral, Dr Michael Saag speaks with Dr Timothy Wilkin from the University of California San Diego about the human papillomavirus (HPV) and anal cancer with options for screening, prevention, and vaccination.

They provide an overview of HPV and the types of HPV that lead to cancer. They discuss screening and prevention for anal cancer at HIV and PrEP clinics. They also discuss the findings of the ANCHOR study that demonstrated that high-resolution anoscopy screening detects and prevents anal cancer caused by HPV. Finally, they review HPV vaccination, its effectiveness, and the challenges with uptake of the vaccine in the population at large.

0:00 – Introduction

1:32 – Overview of HPV

3:01 – HPV and cancer

4:43 – Screening and prevention for anal cancer at HIV and PrEP clinics

9:38 – Findings of the ANCHOR study – efficacy of high resolution anoscopy in detecting anal cancer caused by HPV.

11:32 – Barriers to screening and treatment

15:05 – HPV vaccination - recommendations and efficacy

18:10 – Challenges with HPV vaccination uptake

24:30 – Next ten years of HPV and closing remarks

Resources and articles:

Single dose HPV vaccine article
https://pubmed.ncbi.nlm.nih.gov/35693874/

ANCHOR trial
https://pubmed.ncbi.nlm.nih.gov/35704479/

CDC OI HPV guidelines
https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/human

International Anal Neoplasia Society (guidelines and HRA training)
https://www.iansoc.org

__________________________________________________

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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...