‘Psychosocial behavior’ a key to HIV treatment
Caption: Dr. Eric Daar M.D.
PV’s Dr. Eric Daar and LA BioMed pioneer HIV/AIDS care
HIV/AIDS is no longer a death sentence. Just ask Dr. Eric Daar. “I’ve been treating HIV/AIDS patients since very early in the epidemic, when we spent most of our time just helping people die comfortably, until now, a period when we’re giving people hope. The majority of our patients hope for a long, healthy life,” said Daar. However, it is still a threat and we must continue spreading awareness and advocating for HIV Prevention.
Dr. Daar is chief of HIV Medicine at L.A. BioMed, practicing at Harbor-UCLA Medical Center in Torrance. This Palos Verdes resident, Southern California native and Georgetown University grad also works at Harbor as an investigator of medicine and teacher, and is a professor of medicine at Geffen School of Medicine at UCLA. “Too many titles,” he said with a laugh. Daar completed his residency and fellowship in infectious diseases at Cedar Sinai, served on the faculty and became chief of infectious diseases at Cedar. His tenure at Harbor “is about 10 years.” Los Angeles Biomedical Research Institute is acknowledged to be among the nation’s leading nonprofit facilities in health studies. In addition to research, L.A. BioMed trains young scientists and provides community services in most areas of health care.
Day by day
During a traditional work day, “I’m engaged in patient care. We have a clinic here at Harbor-UCLA campus where we take care of about a thousand people who have HIV, and then we have another clinic in a county-funded comprehensive care center in Long Beach, where we take care of about 250 patients. I’m involved in the direct care of these patients plus the teaching of our infectious disease fellows about HIV medicine” said Daar.
“In addition, in the afternoons I see patients admitted to the hospital who have HIV, most of the time, but occasionally with general infectious diseases where I depend on the consult service.” With the consult service, Daar said his staff sees every patient admitted to the hospital, regardless of what brought them to the facility. He teaches the fellows about managing HIV in-patients. “The nice thing is that when we have these patients in the hospital, we get to know them very well and, when they’re ready for discharge, they’ll often come back and see us in the clinic,” said Daar.
Harbor deals with what he calls a “challenged population. We take care of a lot of indigent, poor, immigrant patients, but we’re able to increase the likelihood that they will come back and improve with continuity of care. HIV care is really among today’s miracles of modern medicine in that we can take people who we meet in the emergency room who are diagnosed with advanced AIDS, get them through their complications and get them into clinic and then completely give them their lives back,” he said.
Initial involvement in HIV care
Part of Daar’s interest in HIV/AIDS stemmed from growing up when the disease first emerged. “I was in medical school when HIV/AIDS was first prescribed in Washington, D.C., when I was at Georgetown. Then it really began to explode in the years of my residency,” said Daar.
“During my training I started working in a research laboratory and became increasingly engaged in clinical research. It was interesting to be involved in something so new, at the very earliest stages, that was clearly to become something really big. And, I think I was attracted to it because it involved people who were my peers who were mostly my age. We were dealing with this life-changing diagnosis and early death.”
More research
Though the care and treatment of HIV is making great gains, Daar’s research continues.
“When I’m not dealing with patients,” said Daar, “we have a pretty large research program where we are doing everything from trying to understand why HIV causes disease, which includes everything from immune suppression – which is what most people think about – as well as a large program studying the affect HIV has on the brain, which we know is another major target for HIV infection.”
He also said there are current programs linking HIV and its treatment to other organs in the body, including the heart, liver, kidneys and bone. “We have studies on how to treat HIV itself; what are the best, safest and most tolerated of combinations, or cocktails, of drugs that can be used to help patients completely control the virus to live a normal, healthy life,” said Daar.
Psychosocial behavior
Treatment for HIV/AIDS only works if it is followed specifically, which involves a patient’s living, working and general social conditions. Variance from the prescription is dangerous.
“When I first started doing this,” said Daar, “everybody died; everybody I met was going to die. Then the therapy got better, but not perfect. We worked very hard to keep people on treatment, and then managed all their complications from treatment and convinced some that it was all worthwhile. If you do that, things would be great, but we often could not.”
He said that present treatments are incredibly easy to take, well-tolerated and successful as long as the person has the stability in his/her life to do it. “We now have two groups of patients,” said Daar. “One group is doing fantastic, in which case I’m taking care of them as a general internist – managing their diabetes, hypertension, getting them to stop smoking, exercise and eat right. Then we have the second group – which is not a small number because we deal with a challenged patient population — who are homeless, have disheveled lives, who might be dealing with alcoholism and drugs and psychiatric disease. These are psychosocial issues.”
The latter group of people either don’t come in and get diagnosed at all, or, once they are diagnosed, they don’t come to clinic consistently, said Daar. “That’s the kind of people who get into trouble with HIV and progress with all the symptoms of HIV or full-blown AIDS,” he said. They are still dying. There is a movement in research now to try to figure out how to deal with this group. Because the treatments are really good, it’s now dealing with the people who are not able to take the treatments because of these psychosocial problems that is a big concern.”
Daar said there are two major studies that he and L.A. BioMed are starting – one next month and the other in the next three months – with the concept of testing and care. These studies will use innovative means to identify high-risk people who are not engaging in care. One of the studies uses what’s known as a Patient Navigator, someone who is an expert in all the resources available to the community, including drug and treatment centers. They identify people who are admitted to the hospital who are substance abusers with HIV. The navigators will meet with the patients a dozen times in as many weeks after they leave the hospital and provide them with information, taxi vouchers, bus passes, direct connections with drug and treatment centers, as well as facilitating them to get to the clinic.
“These are the kinds of strategies that intensive case workers or navigators are trying to deal with. Patients are [often] not able to access the great treatments that are currently available,” said Daar.
The role of family and friends
“From the very beginning of this epidemic, we’ve often relied heavily on family and friends. But, sometimes family is an obstacle to effective treatment because patients don’t want to disclose everything to everybody,” said Daar. “There’s pretty good evidence that, if you don’t disclose, it translates into worse outcomes. So, you just try to hide your disease and you don’t take care of yourself; you don’t go to your visits, you don’t take your meds because of fear that someone will find out. We try to get the patients to engage with a few people – family and/or friends – who they really trust so that support can be provided in many ways, including assisting the patients to take their meds on a consistent basis. For those who don’t take them consistently, one of the best ways to solve the problem is to have a family member or friend – particularly someone who lives with them – act as a reminder.”
The Doctor’s rewards
“Having been here since the beginning,” said Daar, “and seeing so many of my patients and friends die from this disease, it’s rewarding to now be at a point where I can meet people who are dying from AIDS and be able to rescue them. I can bring them into the clinic and sit down with them at this dire moment of their lives and be able to tell them with confidence that, if they deal with the psychosocial issues, work with a skilled provider and take their medications, they are likely to live a long, healthy life. Just being able to tell them that is incredibly rewarding because they’re terrified and they’re sure they’re going to die.
“…And to actually make good on that promise by treating these people and literally giving them back their lives….” said Daar. “A year or two later, they come in, and the things they are complaining about are fights with family or relationships that have nothing related to HIV. Although I’m always sympathetic with those problems, I can’t help but smile a little knowing that they never would have dreamed two years ago that the biggest problems they were facing was their relationship or conflict within their family.
“It’s a pretty unbelievable experience. And, I’ve been so privileged to be a part if it, I can’t begin to tell you.”
The Doctor is in the house
Dr. Eric Daar and his family have lived in Palos Verdes for 14 years. “My wife’s job moved from West Hollywood to Costa Mesa about 14 years ago, so we looked on a map to find someplace to live between Costa Mesa and Cedar Sinai,” said Daar. “She came down here to visit – we’d never been here before, living in the San Fernando Valley in Sherman Oaks – and returned to tell me ‘we’re moving to PV.’”
They settled in, both commuting until Daar was offered the job at Harbor UCLA. “For me it was a no-brainer,” said the doctor, for a lot of reasons – not just the geography. The patient population here is wonderful.” Wife Judith of almost 29 years is a law professor and still commutes to Costa Mesa. The two have four sons ranging in ages from 11 to 24. All did or are attending PV public schools.
Time for recreation or hobbies? “I go to the gym a lot,” said Daar. “I get up very early and go to the gym before I go to work. It’s really the one thing I do for myself. And then the rest of my free time is spent with family.” PEN