Horizons Fall 2015

13 NSU HORIZONS who first met Lee when he was an NSU medical student. Board certified in infectious disease and internal medicine, Kenney joined the practice in 2013 at Lee’s invitation. In 1987, AZT (azidothymidine) was the only drug available to treat HIV. Now, there are about 30 antiretroviral drugs. Typically, patients take three antiretrovirals from two differ- ent classes to prevent them from becoming drug resistant. The drugs reduce the amount of virus in the body, even to undetectable levels, but do not eliminate it. With the new drugs, life expectancy for a person diagnosed with HIV at age 20 and getting treatment has increased to 71 years, just short of 79 years for those without HIV. “Now, they are alive, and they are getting older, which is great,” Lee said. “The average age of my patients is slowly going up. I am taking care of 30-, 40-, 50-year-olds where you can really make a change in their lives.” Lee’s biggest challenge is getting HIV-positive patients to take their meds every day, he said. If they don’t, they risk becoming resistant to the drugs. If that happens, the treatment regimen can be changed, but since a limited num- ber of drugs is available, becoming resistant a second time leaves few options. Reducing the amount of virus in the body reduces the chance of spreading it and offers the hope of controlling it. But that hasn’t happened yet. One reason is that since effective treatment exists, many young people are no longer terrified of contracting the virus. “The younger population comes in HIV-positive. They say, ‘it’s not that bad because there are pills for that now,’ ” Lee said. “People who have had it for a long time would kiss the ground, or sell their souls, to be negative.” Another factor is that many young people don’t think they are at risk and have not taken the HIV test, he said. They are the ones largely responsible for new infections. According to the CDC, about 15 percent of the 1.2 million who have HIV in the United States don’t know they are infected. They may have no symp- toms for 10 years or longer. Even those who get a diagnosis may not seek help. Only about half of those diagnosed are getting regular treatment. Lee estimates that Broward County needs twice as many HIV specialists. In part, that’s because many medical students are unaware of the specialty. He welcomes NSU College of Osteopathic Medicine students to his medical center to increase awareness. First- and second-year medical students go to his and other primary care physician offices regularly to learn about patient care. “I like that the students come to the office to learn more about treating HIV. This patient type and disease are ever growing in the U.S., and the number of providers who know how to care for them are shrinking, making HIV providers a scarce resource,” he said. Fourth-year students come to his office for elective rural rotations. His office qualifies as rural because HIV patients are an underserved population. The students get to do more hands-on patient care. “My job is to get as many students as I can into the office to learn that No. 1, [HIV patients] are not lepers; No. 2, they can be taken care of; and No. 3, they need help, and it is a primary-care issue, not a specialty issue,” Lee said. Noah Lee says his work is challenging because it is ever changing, requiring him to be knowledgeable about all areas of medicine.