Jefferson infectious disease doctor talks about telePrEP and the future of HIV care

The Immunodeficiency Center at Jefferson Einstein Philadelphia Hospital opened in 1994 with 40 patients unable to get care from other doctors who were wary of treating HIV patients or didn’t know how to provide the specialized care they needed.

Thirty years later, the center has expanded beyond HIV care to provide psychiatric, dietary, and social work services to more than 1,000 patients.

Jody Borgman, an attending physician at the center and one of its first employees, has had a front-row seat to the medical evolution. Borgman, who stepped down as medical director of the center in 2023, spoke to The Inquirer about its work and the future of HIV care in an interview edited lightly for length and clarity.

A couple years [after we opened] there were newer medications, what became known as highly active antiretroviral therapy (HAART). It was a highly aggressive retroviral therapy that was very effective, but difficult to take — pill regimens of 15-20 pills a day, with lots of side effects.

The medications and regimens became simpler, more tolerable, fewer pills.

By 2006, we had a triplet — a single tablet containing three medications. People could take just one pill a day and it was, for many patients, very effective.

The concept of PrEP (pre-exposure prophylaxis) became a major thing in the last three or four years, though it came onto the market about 10 years ago. This is probably the key for us to hopefully, eventually eliminate the HIV epidemic. We’re still far, far, far from that. But if you can identify people who are at risk and get them on a treatment regiment that’s easier and easier to do, you can dramatically decrease the risk of becoming infected and spreading to others.

It’s telemedicine for PrEP. We can start people on PrEP without them ever coming into the office. Staff reach out and go over with them what it involves, and keep in touch. They work with doctors here and are started on these regimens and can receive the medications by mail or pick up at a pharmacy.

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That is the most difficult part. It’s educating people, targeting the highest risk groups — men who have sex with men, people who use injectable drugs and people who may be paying for sex. Anyone who has unprotected sex is at risk.

Our outreach includes advertisements, public awareness campaigns to make people aware we’re working within the community already.

In the health-care community, there’s less stigma. Primary doctors are certainly not turning people away. But there are still a lot of patients who feel they are stigmatized by having this infection and don’t want to share with their family and friends.

We’ve come such a long way in the treatment of HIV. The medicines have gotten to be very simple.

There was a time going back 15-20 years where the regimens were changing so quickly, someone who wasn’t concentrated in this area would have a hard time keeping up. But now general practitioners can do this as a routine service and not necessarily be part of an HIV center.

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A majority of our patients are very well controlled on treatment regimens. We spend more time helping our patients with diabetes, high blood pressure. HIV has become, by far, the least of their medical issues.

I’ve had some patients for well over 20 years, and they are still surprised that HIV is such a minimal part of their health because when they came in, it was their most pressing health issue. Now it’s just a side note.

The fact that we are so tuned in to patients, and treating their physical health needs as well as any psychosocial issues involved with coping and dealing with this illness — it provides an extra layer of support. That wouldn’t necessarily be available in a primary care office, where they’re not concentrating on HIV.