Blog: ID Clinic Director Claire Farel, MD, MPH, Answers Most Common Patient Questions

Claire Farel, MD, MPH, medical director of the UNC Infectious Diseases Clinic.

Claire Farel, MD, MPH, medical director of the UNC Infectious Diseases Clinic.

Claire Farel, MD, MPH, is an assistant professor of medicine in the UNC School of Medicine and medical director of the UNC Infectious Diseases Clinic. In answering the most common questions she is asked as a clinician, Dr. Farel illustrates the vast prevention and treatment services available at the clinic, and how they can be accessed.

I love it when patients ask questions. Being able to partner with patients in their care keeps all of us in the UNC Infectious Diseases (ID) Clinic going. Asking questions shows that patients and their families are engaged in what all of us find most important: a healthier life, an understanding of illness and treatment, reliable information to pass along to others, support during stressful times, options for prevention of infection, maybe even a lasting contribution to science.

There are some questions I get more than others. The following are some of the perennial favorites:

“My significant other has HIV. What can I do to keep from getting it?”
We love to get the word out about HIV prevention resources. If your loved one is on HIV medications already and doing well with an “undetectable” amount of virus on blood tests, their risk of passing HIV on to anyone else is greatly reduced by somewhere between 92-100 percent. We call this “treatment as prevention,” but there are other ways to use HIV medications to keep from getting the virus. You can take a pill every day to prevent HIV before an exposure, known as pre-exposure prophylaxis, or PrEP. Using PrEP consistently creates a “shield” in your body against possible infection, dropping the risk of acquiring HIV by at least 90 percent. In an emergency situation (for example, if a condom breaks during sex or in cases of sexual assault), you can take a combination of medications called post-exposure prophylaxis (PEP) to prevent infection after an exposure. There’s a fixed window of time for PEP medications to have a benefit, however – so it’s important to start those emergency medications within three days of the exposure. Our emergency department has expertise in providing this care and our clinic team can assist in accessing preventative medicine if needed.

We are happy to see folks who are interested in HIV prevention in our clinic and can offer lots of resources to make taking preventative medicine manageable and affordable – as well as advice on protecting yourself in other ways.

“How can I arrange to be seen in your clinic?”
We have special programs for HIV-positive patients that allow self-referral – just give us a call (information is included below) to arrange an appointment. We require that most other patients get a referral from a medical provider (such as a primary care provider or another specialist). Having your medical records and the initial workup for your problem allows us to provide a focused, expert consultation. We advise that anyone at risk gets testing for HIV and hepatitis C as recommended by the CDC (Centers for Disease Control and Prevention), either through regular healthcare provider, free testing events, or local health departments. We take referrals from all of these sources and provide hepatitis C treatment through our clinic if you have a new or longstanding diagnosis.

Our contact information is below, or many practices can send referrals electronically.

UNC Infectious Diseases Clinic
101 Manning Drive, 1st floor Memorial Hospital
Chapel Hill, NC 27599
Phone: 984-974-7198
Fax: 984-974-4587
http://www.med.unc.edu/infdis/clinical-care/infectious-diseases-clinic

Our mission is to provide excellent clinical care and education for all of our patients, whatever their concern, and to offer them every advance and advantage in our field to keep them healthy. Keep asking questions!

For more information and commonly asked questions, please visit the Institute for Global Health and Infectious Diseases Blog!

UNC CFAR in the News: HIV drug linked to higher suicide risk

The UNC CFAR is getting exciting news coverage! Our researchers Katie Mollan, MS, Joe Eron, MD, Kevin Robertson, MD, and ACTG investigators have been featured in WedMD, Harvard News, and MedPage Today for their new article which explores the risks of anti-HIV drug efavirenz. This drug appears to double the risk that patients will develop suicidal thoughts or take their lives.

Study co-author Dr. Joseph Eron shared that “Efavirenz is a very important and effective antiretroviral medication that is the foundation for much of HIV therapy worldwide.” Dr. Eron explained that “suicidality (i.e. suicidal thoughts or suicidal behavior or suicide death) is a very serious adverse event that requires clinicians to actively engage patients to assess risk”. This new study demonstrates a clear association between efavirenz and suicidality.

Although the absolute risk of suicidality is relatively small, Eron explained that it appears to be persistent, lasting as long as patients take the drug. Antiretroviral treatment typically is lifelong, helping people with the AIDS-causing virus live healthier lives.

“Clinicians should be aware of this ongoing risk, and talk to their patients to assess suicidality,” Eron added. That means looking for any history of depression or suicidal thoughts or attempts, the study noted.

Good alternatives to efavirenz do exist for patient who may need to start, or to switch to, another therapy. In settings where alternative therapies are not available, the benefits of efavirenz-based therapy with management of depression will usually outweigh the risks of no treatment, especially for people with low CD4 cell counts.

Follow the coverage:

WebMD: “Common HIV Drug May Boost Suicide Risk”

Harvard News: “Widely Used HIV Drug Linked to Higher Suicide Risk”

MedPage Today: HIV Drug Linked to Suicidality Risk

Video Clip: The link between Efavirenz and Suicide