HIV Clinic meets changes in disease and treatment for 28 years

Entering its twenty-ninth year of operation, UIHC’s HIV/AIDS Clinic has grown from a service of the Infectious Diseases Clinic into a multidisciplinary organization serving around 600 patients. Since 1988, more than 2,000 patients have been seen in the clinic.

StapletonJackAs the primary organizer and Director of the clinic, Dr. Jack Stapleton of the Division of Infectious Diseases attributes much of that growth to the improvements in drug therapies over the past two decades. The first drug to treat AIDS successfully, azidothymidine (AZT), came out one year before the clinic opened, but despite the medication’s efficacy in treating advanced patients, the drug became less effective in most people within a year or two due to the development of resistance.

The clinic plateaued at approximately 200 patients between 1989 and 1996, as a result of a mortality rate that nearly matched the influx of new patients. The advent of the HIV three-drug “cocktail” in 1997 improved the health of many patients and extended longevity. (In fact, many of the clinic’s patients participated in research studies that contributed to the development of these drug cocktails.) “If you walk in the door today with a new diagnosis of HIV, and you take your meds, your life expectancy is pretty close to that of people without HIV,” said Dr. Stapleton.

Besides changing the prognostic face of the disease, new medications have also drastically altered Dr. Stapleton’s profession, he says. “My role in the HIV clinic during the first 15 years was almost exclusively dealing with the infectious diseases aspects of the disease. Many of the chronic illnesses that we care for were not as prominent then, as our patients were frequently having acute health crises caused by infections. Now, in addition to my infectious diseases work, I am able to serve as a general Internal Medicine specialist as part of managing HIV medication side effects and more common problems like hypertension, diabetes, and hyperlipidemia.”

Still, one challenge of HIV care is the stigma attached to the disease, even though that stigma has dramatically lessened over the decades. UIHC was the first healthcare system in Iowa to provide services in a clinic solely devoted to caring for patients living with HIV/AIDS. At the time, Dr. Stapleton and his colleagues chose to call the service the “Virology Clinic,” both to provide some confidentiality for patients and to prevent concerns in clinic patients attending adjacent clinics. Even the name of the disease went through changes; it was originally called “GRIDS,” or “Gay-Related Immune Deficiency Syndrome,” as the disease was first recognized in gay men. Once it appeared in other populations, the name was changed to AIDS. Today, the outstanding team of social workers, nurses, physicians, physician assistants, and nurse practitioners involved in patients’ care continue to educate patients, families, and their communities to diminish prejudice against people living with HIV.

There are many very good clinics throughout Iowa and the surrounding areas, but there are several reasons why many patients still seek care at UIHC. First, UIHC has the largest number of HIV specialists in the state, something simply not available in other areas of the state, particularly in rural communities. Second, due to concerns about confidentiality in their communities, many people prefer to travel to UIHC for their care. Third, the multidisciplinary services of UIHC’s HIV clinic make the trip well worth it. “I think our patients get outstanding care, in large part due to the team of clinical, social work, and nursing professionals with experience and passion for our patients,” said Dr. Stapleton.

Those services include communication with insurance companies to ensure coverage for costly medications. Some insurance companies, including Medicare and Medicaid, classify many expensive drugs, including most HIV medications, as “non-preferred.” To obtain these, the clinic’s nurses and providers must obtain special authorization, even if the patient has been on the medicines for years. Thus, the nursing and provider staffs have to file considerable paperwork for many prescriptions, in addition to their regular duties reviewing lab results and caring for patients. UIHC is well-versed in how to do this efficiently.

To fund its many services, the clinic relies heavily on the Ryan White HIV/AIDS Program, created in 1990 and administered by the Health Resources and Services Administration. One aspect of the program provides funding to local organizations to support HIV outpatient, early-intervention services and ambulatory care, and also pays for a portion of physicians’ salaries, nursing, some social work, and many patient-direct services. UIHC’s clinic has earned this competitive funding continuously since 1998, which also speaks to the quality care the clinic provides.

Because many of the clinic’s patients are socially disadvantaged, the clinic also receives funding through Housing Opportunities for Persons with AIDS to cover everything from indigent housing, taxi service to the clinic, prior authorizations, and data collection.

“The treatment goal is to have 90 percent of our patients have non-detectable virus [viral load], and I think we’re one of the few clinics in the state, if not the Midwest, that has been able to achieve this goal,” said Dr. Stapleton. “Part of being able to take your meds is having access to social services, having a home, a place to live. Homelessness is often a problem; mental health is a big issue. So we try to serve all those needs.” Dr. Stapleton encourages referring physicians in and outside the Department of Internal Medicine to send persons living with HIV/AIDS to the clinic for evaluation and care.

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