A 35-year-old physician based in Philadelphia, Dr. Helen Koenig primarily treats patients with HIV. In her lifetime, AIDS has gone from a death sentence to a disease patients can live with for decades.
This past week, she's been attending the International AIDS conference in Washington, D.C. -- her first -- and its themes and findings are part of the highs and lows of her life as a physician who treats HIV.
Koenig started practicing two years ago at the Jonathan Lax Center, a community HIV clinic that is part of the comprehensive AIDS service organization Philadelphia FIGHT.
"As a young HIV doctor, this was going to be a landmark conference that I couldn't miss," said Koenig. The location itself was historic, marking the return of the conference after more than two decades, thanks to the federal government's recent lifting of the ban on travel visas to the U.S. for people with HIV.
The conference hasn't disappointed. Thirty years after the beginning of the AIDS epidemic, 30 million deaths and untold human suffering later, experts have finally dared to speak of "turning the tide," on the epidemic, and -- perhaps even more boldly -- a cure.
"Exhilarating" is how Koenig describes it. "It means that I can go back to Philly and now tell my very young patients that they will likely see a cure in their lifetime. Even if that's five years, 10 years, or 50 years, there is now a light at the end of the tunnel for them.
"It means I can say that we need to use medications until there's a cure... This will change their whole outlook on their disease."
And the face behind hope for a cure? Timothy Brown, the so-called "Berlin patient," who announced this week that he remains HIV-free five years after a stem cell transplant from a donor with a rare genetic anomaly that offers immunity from HIV.
Koenig met Brown briefly at a meeting last summit hosted by Philadelphia FIGHT. She thought he was "kind" and "humbled to have found himself the only known person to ever be cured of HIV." And she thinks his success story has inspired a push for a cure. "He is the face of the search for a cure, just like Ryan White was the face for HIV funding years ago."
But she was quick to note that the conference was not all optimism. Her favorite speaker was Annah Sango, a 24-year-old woman living with HIV from Zimbabwe who spoke at the opening plenary about "women making waves in the tides of change." But Sango's hopeful outlook was tempered by a reminder of so many conferences in the past where women have demanded equality in HIV care, but still have not received it. "Why do so many of the same old problems still exist and hinder women and girls from accessing the care, treatment, and support we need?" Sango asked.
As the week progressed, "treatment as prevention" was a hot topic amongst conference goers. There is now proof that treating people with HIV early -- rather than waiting for their CD4 immune cells to drop -- can help to prevent transmission of the virus to others. This represents a shift from thinking about HIV treatment as directed toward the individual to thinking about the potential benefit to communities.
Koenig said this new information will be helpful for counseling patients with new diagnoses of HIV.
"For patients who are reluctant to start treatment for their own benefit, they may be motivated to know that they can help to prevent transmission of the virus to their loved ones," she said.
Another topic of discussion among researchers this week was new research related to pre-exposure prophylaxis or PREP, a once-daily pill to prevent HIV among those who are uninfected. Researchers are now looking for other ways to administer PREP, such as a monthly injectable, or a vaginal ring that could deliver both PREP and hormonal contraception.
For Koenig, whose research interests include HIV prevention among young men who have sex with men, this discussion spark renewed interest in how clinicians can deliver PREP quickly and effectively.
The results of one study showing that young black MSM (men who have sex with men) living in urban areas in the U.S. acquire HIV infection at a rate of almost 6 percent per year -- three times that of U.S. white MSM -- generated great interest among the public. "Unfortunately, it's very common for me to see young black men who have sex with men in my clinic with a new diagnosis of HIV," Koenig said. "It's just devastating, especially to see young men who have relatively advanced disease."
She does, however, see the AIDS conference as a way to generate public awareness about AIDS in general, and racial disparities such as these.
"Friends and family who don't usually ask me about HIV are calling because they've heard about the conference," she said. "This is a special opportunity to teach people about HIV and raise awareness."
Aside from a busy schedule of attending lectures, Koenig also juggled having her 7-month-old daughter, Emma, with her at the conference -- "the youngest AIDS activist here," quipped one attendee. But her presence had special meaning for Koenig. "As both a mother and an HIV doctor, having my daughter here put a different perspective on what is means to have an AIDS-free generation.
"For me, this is the best gift we could give our children."