Amy Althoff, MD, is an infectious diseases specialist practicing at the Partnership Comprehensive Care Practice in Philadelphia, where she provides primary care and specialized HIV care. She is also an attending infectious diseases consultant at Hahnemann University Hospital. Dr. Althoff is board certified in internal medicine and infectious diseases.
What made you want to become a doctor?
I decided I wanted to become a doctor at a very young age. I've always loved science and wanted to help people feel better. Being a doctor brings those two things together, so becoming a physician was a logical choice.
Why did you choose to specialize in infectious diseases?
I found infectious disease particularly fascinating because it involves every organ system. I loved internal medicine, and I like to think of infectious diseases as a specialized internal medicine. The specialty enables me to interact with different departments and specialties. Infectious diseases also requires thinking at various levels—from microscopic organisms to one human host, to an entire population. There are always new challenges, which makes it an exciting field. In addition, I've always been fascinated by HIV, and doing infectious diseases enables me to take care of patients with HIV. It is a privilege to see my patients regularly and hear their stories. I serve as a primary care doctor, as well an HIV specialist, so I get to practice both internal medicine and infectious diseases.
How did you become interested in HIV care?
Pretty much for the same reasons. HIV affects all organ systems, and it enables you to think about internal medicine, as well as HIV itself. However, there are multiple other aspects of HIV that are not medicine related, but encompass a broader scope, such as the social impact and the public health impact. Who is affected by HIV? It tends to be a marginalized and vulnerable population, so there are also a lot of bigger issue topics that are wrapped up in treating this one infection.
You have previously done research around HIV care and recently released jail detainees. Can you tell me about that?
When I was a fellow at Yale, I worked in the New Haven jail treating patients who had HIV. Jail detainees are a particularly vulnerable population due to the high turnover. People come in and out of jail. It's very unstable, and people are often released back into the community with very little. They may have had insurance when they came in, but they no longer have it when they leave. They might have had an HIV provider when they came in, but maybe not when they leave. Additionally, substance use and mental health issues often affect this population making engagement in HIV care a challenge.
My research focus has always been on retention in HIV care, and this population in particular is really difficult to retain because, once they're in jail and then released, linking them back to their provider and retaining them in care is difficult. The research that I did basically found that patients who get case management services while they are incarcerated have higher likelihood of being linked and retained in care, which is not rocket science, but it shows that these interventions matter, and they make a difference. We need to put money and resources into them.
How long have you been with Drexel Medicine?
I've been here for five years.
You've been very involved with the U=U campaign at Drexel Medicine. Can you talk about what that is and why it's important?
U=U means "undetectable equals untransmittable." It was started by a group of patients, advocates and activists. Once we had the science to show this, the group asked why providers and researchers were not directly sharing this information with the general population or with patients. They've created a movement to educate people in order to decrease the stigma of HIV. I think it's really empowering for patients to know that if they have an undetectable viral load, they can be in a relationship without the fear of transmission to their partner. I think this information has potential huge implications for mental health in that patients no longer need to feel isolated and stigmatized. They can have a relationship and no longer feel the burden of HIV. It can also motivate patients to become undetectable and to maintain that by continuing to take their medication. We are working hard to deliver the U=U message to our patients, and I would love to extend it to the Philadelphia community.
There still seems to be a lot of misperceptions concerning HIV in the general population. What has changed in how we care for HIV, and what problems are the patients facing today?
Unfortunately, I feel like much of society is behind the times in terms of understanding HIV. There is still a lot of misinformation out there. One of the purposes of the U=U campaign is to combat that and to be transparent with the information that we have. We now have these wonderful medications that—if patients are able to take them and to take them consistently—can suppress their viral loads, making them undetectable. In this case, there is no risk of transmission to partners, but even more importantly, the patients can go onto lead normal, healthy lives that equate to the normal lifespan of others. The medications have done a tremendous amount in terms of extending people's lives. The issue, though, is that not everybody has access to these medications and consistent HIV care.
About 85% of patients who have HIV are aware that they're positive, and about 75% of patients are linked to care. However, there's a huge drop off in retention in care, so only about 50% of patients at any given time are engaged in HIV care. That's really where the issue lies today. We have these great medications, but they only do so much. It's really about reaching the patients that need help and engaging them in care so that their viral load can be suppressed too. Until we get to that point, there will continue to be 40,000 new HIV infections per year in the US.
How does PrEP affect the spread of HIV?
I think that PrEP is vastly underutilized. I think that if the access to PrEP was increased, then we could definitely decrease the number of new infections. It is important to address HIV from multiple angles: getting patients on medications who are positive, and getting people on PrEP who are negative and at risk. We need to be able to have open conversations with patients and really promote these life-saving medications.
The Partnership Clinic just celebrated its 25th anniversary. What makes it a unique place?
I think the Partnership is a very unique and a very special place. We see 1,700 patients a year. It's one of the largest HIV clinics in Philadelphia. We are fortunate to have multiple resources and support staff which are essential to successfully treating our patients. We have a nutritionist. We have a pharmacist. We have a behavioral health specialist who helps link patients to psychiatric care and substance use treatment. We have an outreach team and many case managers. We have GYN care and a nephrologist who comes monthly. We do our labs on-site. We really try to offer a comprehensive package so our patients can do almost everything they need to do in one place. I think most of our patients view the Partnership as a safe place, so if they do not feel well or if they are in a crisis, they know that they can get help. I think patients feel supported, and I think the providers also feel supported in being able to navigate the complex medical system to get our patients the help they need.