Preventing HIV Today: Testing, PrEP, PEP, And Primary Care’s Role with Dr. Cameron Wagenbrenner

Many people still hold outdated beliefs about HIV, leading to fear, missed testing, and preventable infections. In this episode, Dr. Wagenbrenner, an internal medicine physician at MedLink, breaks down the essentials—how HIV affects the immune system, how it differs from AIDS, and why accurate information saves lives. We cover national and Georgia-specific stats, real transmission risks, and the common myths science has long disproven.

We also dive into today’s prevention tools: safer sex practices, PrEP options like Truvada, Descovy, Apretude, and the new six-month injectable, plus PEP and the crucial 72-hour window after possible exposure. Dr. Wagenbrenner explains who should get screened, how rapid and blood tests work, and why easy access to prevention and testing drives down transmission.

Treatment has advanced dramatically, too. Many patients now take one pill a day or receive periodic injections, experience fewer side effects, and reach undetectable viral loads that protect their health and their partners. Dr. Wagenbrenner shares how primary care normalizes these conversations and supports patients without judgment.

If you learned something new, follow the show, share it with a friend, and leave a quick review to help others find trusted HIV prevention and care guidance.

Episode Transcript

SPEAKER_01 (00:02):
Welcome to the Medlake Health Connections
podcast.
In recognition of HIV AwarenessMonth, we're talking about the
basics of HIV, where thingsstand today, and the important
role primary care takes or playsin prevention, testing, and
treatment.
Joining me is Dr.
Waggenbrenner, an internalmedicine physician at our
Medlink Culbert and O'Coneyoffices, where he has been a

(00:25):
part of our team since 2022.
He studied at the University ofGeorgia and attended Mercer
University School of Medicineand completed his internal
medicine residency in Savannah.
Dr.
Wagenbrenner, thank you so muchfor being here.
Can you explain what HIV is andhow it affects the body?

SPEAKER_00 (00:44):
So HIV is stands for human immunodeficiency virus.
It's a viral illness thatinfects normal white blood
cells, cells that we carry inour body to help fight
infection, and it prevents ourability to fight infections when
they're presented to us.

SPEAKER_01 (01:03):
Okay, and how is HIV different from AIDS?

SPEAKER_00 (01:07):
So AIDS is a severe stage or sometimes considered an
end stage of HIV virus.
As HIV persists in the body, itdoes decrease certain white
blood cells called T cells.
And when these levels get lowenough, patients can have
complications from inability tofight infections, sometimes

(01:30):
called opportunistic infections,and even sometimes develop
certain types of cancers thatare seen in patients with AIDS.
It's really just the progressionof HIV without treatment.

SPEAKER_01 (01:43):
Okay.
How common is HIV today, bothnationally and here in Georgia,
or our community?

SPEAKER_00 (01:51):
So most recent studies in the United States
show about 1.2 million people inthe US are living currently with
HIV.
In the United States, there'sabout 30,000 new cases of HIV
per year.
And about one in seven peopleliving with HIV are do not know

(02:12):
that they currently have HIV.
In Georgia, there's estimated tobe about 71,000 people living
with HIV and about 2,500 newlydiagnosed HIV patients in the
last year.

SPEAKER_01 (02:29):
Wow.
So what are the main ways thatHIV is transmitted?

SPEAKER_00 (02:35):
So there are multiple.
Probably the most common or themost common that people acquire
HIV is through sexualintercourse.
Secondly, is usually IV druguse.
Still most prevalent amount ofpatient population that we see
get diagnosed and acquire HIV isin men who have sex with men,

(02:59):
followed by heterosexualintercourse, and then followed
pretty far amount below that inpeople who inject IV drugs.

SPEAKER_01 (03:09):
Okay.
And are there any misconceptionsabout how HIV spreads that you'd
like to clear up?

SPEAKER_00 (03:16):
So I think the fear of acquiring HIV can uh cause
people to have misconceptions onhow it's transmitted.
It requires encountering blood,semen, vaginal secretions,
rectal secretions, or breastmilk, or blood-contaminated
fluids in a person living withHIV.

(03:39):
And it has to be encounteredthrough a non-intact skin, so
with a wound or in contact withan eye, mouth, rectum, vagina,
or other mucous membranes.
You can't get HIV from someonewho's living with HIV if you
encounter contact with theirurine or nasal secretions or

(04:03):
saliva or tears.
So it has to be a prettysignificant interaction with
someone who has HIV to be ableto acquire it.

SPEAKER_01 (04:11):
Wow.
Okay.
And what role does stigma stillplay in HIV prevention and care?

SPEAKER_00 (04:19):
So when HIV was first discovered, there was big
stigmatization about the patientpopulations that it was
initially found in.
And that's persisted for nowdecades since the late 70s,
early 80s.
There's fear that specificallymen who have sex with men,

(04:40):
there's high risk oftransmission, and encountering
that patient population can uhlead to higher risk for
transmission.
People oftentimes are veryfearful to let others know that
they are diagnosed with HIV.
And there's concern that onceyou're diagnosed, that there's

(05:01):
no treatment and it potentiallycould uh result in um end of
life.
Now, most multiple of thosethings that I just mentioned are
either not no longer true or umthe misconception can be kind of

(05:22):
altered in a way that um we canreally prevent the risk of
exposure, transmission, and thenimprove treatment outcomes with
better education.

SPEAKER_01 (05:34):
And how what does that HIV prevention look like
today?

SPEAKER_00 (05:38):
So there are multiple different ways that we
can prevent HIV.
Um obviously, with highesttransmission being with sexual
encounters, um as previouslytermed like sex practices, safe
sex practices, um, irregardlessof medication, um, can still be
very beneficial in decreasingthe um possibility of

(06:01):
transmission of HIV.
And then there are a lot of oralor a lot of medication options,
uh, not only oral options, butalso injection options that
could prevent it.
Um there are two oralmedications uh currently being
prescribed.
The brand names are Discovy andTruvata.
These medicines are taken oncedaily and are greater than 90%

(06:24):
effective in preventing thetransmission of HIV for not only
sexual encounters, but then alsoum potential for exposure with
IV drug use.
And then there are two uminjection options.
Uh the first is called Apertude.
Uh, this is a month, uh, everytwo-month injection after

(06:44):
getting two injections uh twoone month apart.
So every two-month injectionfrom there.
And then recently in June, theFDA came out with a new medicine
called Yes2Go.
Um, that's an every six-monthinjection for the prevention of
HIV and currently being studiedfor potential of just doing it
every year.

(07:05):
So there's really four medicinesout now that we can use to
prevent HIV that are veryeffective.
Um, it depends on patientpreference on which ones we use,
um, but all are very effectiveand if taken correctly, can
really prevent or decrease thelikelihood of transmission of

(07:26):
HIV if there is uh significantrisk exposure to someone with
HIV.

SPEAKER_01 (07:32):
Okay.
So can you tell us a little bitabout CREP and PEP, which I feel
like you kind of did, and howthey signal it?

SPEAKER_00 (07:43):
Yeah, so um I think a lot of patients will come in
knowing um these acronyms thatare set up.
PREP stands for pre-exposureprophylaxis.
And those are the medicines thatI um just talked about.
These are medicines that youtake either daily in oral form
or injection every two to sixmonths, depending on the um

(08:07):
formulation that is used, andthey help prevent the um
possibility of transmission ofHIV into someone who is HIV
negative.
PEP or PEP stands forpost-exposure prophylaxis.
This is in someone who has notbeen taking pre-exposure
prophylaxis, who has had asignificant exposure and

(08:31):
increased risk of acquiring HIVwhen encountering a situation
where they're exposed to HIV.
One of the big caveats with PEPor post-exposure prophylaxis is
that it has to be started within72 hours after the exposure to
be effective.
And if it's not started withinthat time period, um, is not

(08:51):
seen as effective and actuallycan be harmful in terms of not
starting correct treatment ifHIV is acquired.

SPEAKER_01 (08:59):
Okay, well.
Um, when should someone gettested for HIV and how often?

SPEAKER_00 (09:05):
So currently, the recommendation from the United
States Preventative Task Force,who makes rec recommendations on
many of our preventionstrategies in the United States,
recommends that anyone over of15 to 65, so anyone between 15
and 65 should be screened oncein their lifetime for HIV.
Now, in certain populations athigh risk for potential of

(09:28):
acquiring HIV, they should bescreened more frequently.
Those are in patients who havehad a recent sexually
transmitted infection, theyshould also be checked for HIV
at that time.
The patients at increased riskfor sexually transmitted
infections uh or potential ofHIV through sexual encounters

(09:50):
should be checked every sixmonths to a year.
Patients who inject drugs shouldalso be checked every six months
to a year.
And then certain patients whoare starting what we call
immunocompromising or medicinesthat can decrease the immune
system should be checked for HIVon a more regular basis as well.

SPEAKER_01 (10:08):
Okay, and what types of tests are there that are
available now?

SPEAKER_00 (10:13):
So all testing is done through blood testing, but
there are what we call rapidtesting.
Uh, this is just a finger prick,usually in the office setting,
that gives you a rapid resultwithin a couple minutes on the
possibility of HIV positivity ornot.
There are blood draws that aretaken through a vein sample and

(10:34):
sent off to a laboratory fortesting, and those usually
return within 24 to 48 hours.
Um the both of these tests arevery accurate.
Sometimes when we do thesetesting, we do require secondary
testing to confirm it.
Um, but overall, when you groupall the types of blood testing

(10:55):
we can do for HIV, it's nearly100%, I'd say 99.some percent
accurate.
Um, and so these are very umaccurate testing and relatively
quick to return um to know theresults.

SPEAKER_01 (11:10):
Okay, and if someone were to be diagnosed with HIV,
what does treatment usually looklike?

SPEAKER_00 (11:16):
So this has changed tremendously over the last 20 to
30 years.
Most people who are currentlyliving with HIV and on treatment
are getting oral medications.
Um, it's sometimes that peopleare having to take a few pills
either once or multiple times aday.
There are regimens now wheresomeone just takes one pill once

(11:38):
a day.
There are some people who getinjection medicines less
frequently, sometimes on monthlybasis, up to every three months
basis.
So the amount of pills orfrequency of treatment has
decreased quite tremendously.
Um, old HIV medicines thataren't used very frequently also

(12:01):
had quite a few side effects andwas a downside and a reason that
a lot of patients maybe weren'tas um compliant or uh perfect
about taking their medicines asneeded.
Um, but now most of the sideeffects of the medicines are
quite tolerable, if any, andpatients usually are able to

(12:22):
follow a regimen that is veryeffective in decreasing the
amount of HIV that is in theblood samples.

SPEAKER_01 (12:32):
Okay.
Um and how effective are thesemedications in helping people
live healthy full lives?

SPEAKER_00 (12:39):
These are very effective medicines.
Um, HIV, when it was initiallydiscovered, was considered a
death sentence because therewasn't effective treatment.
But currently we have treatmentthat can decrease viral loads or
the amount of virus in the bloodto um levels that are considered
what's considered undetectable.

(13:00):
Um, the amount of virus is sosmall that uh our lab samples
can't actually pick up thatamount of virus.
Um patients now living with HIVcan live nearly um the amount of
lifespan as someone who is notliving with HIV.
There is some small decrease inthe um potential lifespan of

(13:28):
people with HIV, but it reallyis getting closer and closer as
we get new treatments to beingsimilar to people who are living
without HIV.

SPEAKER_01 (13:38):
Oh, wow, that's amazing.
Um, as a primary care provider,how do you approach
conversations about HIVprevention, testing, or
treatments with your patients?

SPEAKER_00 (13:49):
So I really bring it up with all of my patients.
Um, I think that if it's kept inthis silo of only bringing up
with people who are willing todiscuss maybe their sexual
practices or history of drug useor concerns for HIV, you're
missing a large amount of peoplewho could benefit from HIV

(14:13):
testing.
Um, as that's statistic, I saidearlier, one in seven people
that have HIV are needed oraware.
Um, and oftentimes patients arefearful or embarrassed to talk
about potential risk factorsthat could put them at risk for
acquiring HIV.
It's best as a provider that tojust bring it up with patients

(14:34):
and make it seem like it's anormal thing that we do and test
for every single day, which itis, makes people feel more at
ease.
And if we diagnose the disease,then you can get on treatment
quicker, you decrease your riskof transmitting it to other
people.
Um, HIV has definitely becomemore of an ability for primary

(14:56):
care providers to treateffectively, whereas in previous
years it was more in HIVspecialty clinics, but the
simplicity of medicines we usemakes it much more accessible
for primary care doctors.

SPEAKER_01 (15:11):
Okay, wow.
Well, thank you so much forsharing your insight with us
today.
Um, is there anything, any finalwords you might have to say?

SPEAKER_00 (15:20):
I think I would just encourage everybody, even if you
have low or no concern for HIV,bringing up the possibility of
getting testing through aprovider.
It always helps to be asknowledgeable about your health
as possible.
Um there have been unexpectedcases of patients being positive
without them expecting it.
There are very effectivetreatments now that can help not

(15:43):
only your long-term health, butalso your health of loved ones
that are potentially at risk forHIV acquisition.
So just bring it up to yourprovider and get more people
tested.

SPEAKER_01 (15:58):
Thank you for tuning in to the Medlake Health
Connections podcast.
We hope you found today'sepisode informative and
inspiring.
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Remember, the information sharedin this podcast is for
educational purposes only andshould not replace professional
medical advice.

(16:20):
Always consult with yourhealthcare provider for any
medical concerns.
Stay connected with us on socialmedia and visit our website at
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Until next time, stay healthyand take care.