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Saturday 11 April 2015

Check-up: Dr Charles Farthing

Posted in: HIV
By Jacqui Stanford - 27th March 2014

Dr Charles Farthing
New Zealander Dr Charles Farthing is the Asia Pacific Director of Medical Affairs for HIV and anti-infectives at Merck Sharp & Dohme. We caught up with him on his work, and issues like PrEP, treatment for prevention, discrimination and the ongoing search for a cure, during his recent visit home.

Dr Farthing spends a lot of time with doctors who are interested in doing drug research, as when drugs are created they have to go through extensive clinical trials to prove their safety and efficacy.

“There are many other studies that might be done, maybe for different indications or for different reasons, and independent researchers, doctors who are working in infectious disease, often want to do these things,” he explains.

“So they ask the company for funds to do research, and it helps us of course because we learn about our products. We liaise with doctors about that and help them write their protocols and design their studies and get them approved. And we also, being physicians, we have a role of education within the company.”

Because he was an AIDS physician for many years in the US and UK, he is often asked to lecture about AIDS in general, especially in China. “And sometimes I see patients to help educate. I quite enjoy that.”

Dr Farthing says something which is happening in Asia, as well as in North America and Europe, is a huge epidemic of unsafe sex among young gay men.

He says even in countries where the epidemic did not begin as a ‘gay disease’, like China, where it began as a heterosexual transfusion and intravenous drug user related, “now they have roaring gay epidemics in all the big cities … wherever you look.

“That’s a real problem, but it’s a problem throughout Asia. Every single Asian mega-city you talk to is seeing the same, Hong Kong, Bangkok in particular. That’s a big, big problem and it’s a very hard one to address, because the scare of dying of AIDS is gone away so condom education is so much more difficult, and I think for the majority of young people, impossible.

“So that’s why the medical community is looking at so other many alternatives, in the form of PrEP in particular.”

PrEP, or Pre-Exposure Prophylaxis, is a method where people who don’t have HIV take a daily pill to reduce their risk of becoming infected.

Dr Farthing says it’s terribly difficult. “It’s difficult enough to get an HIV infected person to take their pills every day. To get an HIV uninfected person to take their pills every day so they don’t get infected, is a bit of a pipe dream.

“They’ve done clinical studies and PrEP definitely works if you take it, but some of the studies have completely failed because even the study participants, who are presumably the keenest people you can get, didn’t comply and didn’t take the treatment.”

Dr Farthing says there are studies being done by other drug companies which may pave the way for people to have an injection once every three months to protect themselves. “If that comes out, which it probably will in two or three years’ time, I think we really could have effective PrEP. You could bring these young gay men into clinic and just give them one shot and ‘say see you in three months’ and that will protect you. Of course it won’t protect you from syphilis and gonorrhoea, but then they can be treated for those and have the disease eradicated. But it would be nice to protect them from HIV which is a disease which can’t be eradicated.”

When it comes to treatment for prevention, Dr Farthing says the HIV/AIDS medical profession is still somewhat divided. He is clear on his stance. “I’ve always been a strong advocate for treatment for prevention. I believe we are steadily winning the battle against naysayers.”

He says one of the heroes of the cause Dr Julio Montana has carried out research in Vancouver showing the more people on treatment, the less new infections you see. “This has been demonstrated in South Africa, in San Francisco, in studies in Denmark, but there are some other countries where it doesn’t appear to be the case,” he says.

“For example Britain and Australia, where there’s very high treatment penetrance, meaning about 80 per cent of HIV infected people are on treatment. And yet despite that … the number of new cases is rising.”

Dr Farthing thinks that may be due to the previously-mentioned trend of unsafe sex among young gay men. “(It’s) resulting in a lot of new cases, which is even offsetting the improvement we’re seeing in other countries from treatment for prevention.”

He agrees this underlines the importance of regular testing. “In a way that’s the biggest single problem, it’s the testing - because if that was universal and routine we wouldn’t have these large percentages of undiagnosed people that are really the ones that are keeping the epidemic alive.”

Dr Farthing points out in many places around the world, testing is not free, and physicians who are not educated about HIV are uncomfortable, as they don’t know how to handle the situation if the test comes up positive. “If we continuously to push for routine testing of everybody, then we’d do much better with our epidemic.”

As for treatment for prevention in New Zealand, he thinks the situation here would probably be very similar to Australia or Britain.

“There is already very good medicine. The doctors take very good care of the patients. Community groups are very active in education. The patients are really generally pretty compliant with their treatment. Eighty or 90 per cent of the diagnosed patients are probably on treatment, so treatment for prevention in many ways is already working here.

“But, as I was talking about earlier, it may well be offset by this epidemic of unsafe sex with very young gay people, who are now connecting much more easily through social media and websites like Grindr and are very sexually active, under the radar and sort of unreachable. They don’t even go to the gay bars these days.”

Overall, he thinks New Zealand has done “a fantastic job” in the face of HIV, pointing out our infection rate is very low, on a global level. “I think that is because at the very beginning of the epidemic the country was sensible, the Government was sensible, the gay community was sensible, and they mobilised a lot, advertised a lot about the concern, so the disease didn’t spread like wildfire. And at the moment there are still only a relatively small number of people infected.”

Dr Farthing says as drugs have essentially stopped people dying, there are of course more people living with the disease than there used to be. “But if they are on treatment and well-controlled they are unlikely to spread the disease. So the number of new cases is not necessarily going up, if anything it’s coming down, even if the number of people living with HIV is rising all the time.”

One thing which surprises him is that discrimination remains an issue in New Zealand, still. “Perhaps that’s because the disease is left in the press, for obvious reasons, people aren’t dying in large number as they used to, so it’s not as scary an item for the news media to report. And so with less visibility people don’t get educated out of prejudice,” he says.

“We see it in hospitals, even in Hong Kong where I am, that the patients complain that the doctors and the nurses are prejudiced sometimes. I’ve noticed that in America too, if you put a patient on a ward where they’re not familiar with the disease … that’s why we used to keep people in specialised units.”

Now though, with fewer inpatients, there are no separate units with specially educated staff. “Less educated workers show concern which is interpreted as prejudice,” he says. “That’s not nice.” This is why he feels strongly that education remains important, as do movies like Dallas Buyer Club which point out how horrible prejudice is.

As for the ongoing hope for some kind of cure, he says there is a big push in this area at the moment, particularly from Françoise Barré-Sinoussi, the Nobel Prize winner who discovered HIV in 1983. “She has been a huge advocate of this and there have been many labs working on HIV cure research around the world, including the Merck lab. And there are different approaches.”

Dr Farthing says other paths are now being followed more keenly because vaccine research has been so unsuccessful. “HIV seems to be one of those diseases that you can’t develop a vaccine against because the body has no known immunity to HIV. Even people who are infected with HIV can be super-infected with different strains very easily, we now realise.”

He says it seems that just like syphilis, if you got cured you could still get re-infected. “Even if we could eradicate it, I am sure you could catch it straight away again, because there’s no natural immunity. If there’s no natural immunity it’s very difficult to develop a vaccine to try and induce something that doesn’t exist in nature.”

Of course though, the world continues to look for an answer. “You’ll hear a lot of noise about HIV cure research, but whether we’re a few years away, or decades away from actually curing people, we don’t know.”


Jacqui Stanford - 27th March 2014

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