Dr. Caroline Isner, head of the Department of Infectious Diseases at the Vivantes Auguste-Viktoria Hospital, aims to be at the side of HIV patients and to further develop antibiotic stewardship.
Interview with Dr. Caroline Isner on the topic of HIV/AIDS
In the midst of the coronavirus pandemic, perhaps Germany's best-known HIV/AIDS clinic has a new chief physician. Dr. Caroline Isner's goal at the Vivantes Auguste-Viktoria Hospital is not only to continue to be at the side of HIV patients, but also to further develop antibiotic stewardship. The infectiologist explains in an interview what this means in times of COVID-19.
Let's start with the most current topic. What does Corona mean for people with HIV/AIDS?
Dr. Caroline Isner:We now know that patients with virologically controlled HIV disease and a helper cell count > 200 do not belong to the risk group with regard to severe COVID-19. This has already been shown in initial studies.
How does patient care work under coronavirus conditions? How does it work in the outpatient clinic?
Isner:Our outpatient clinic continues to care fully for the patients with HIV/AIDS, but also for infectious disease patients. To avoid the risk of infection, all employees work with FFP-2 masks and special hygiene measures have been introduced. In addition, we are always available for our patients with HIV/AIDS through our infectious disease on-call service and our outpatient clinic, even on weekends.
Are your patients afraid of contracting Corona?
Isner: I understand that patients are concerned about contracting Corona in the clinic. To prevent this, we have also taken special hygiene measures in the hospital and adapted them to the current situation. Upon admission, all our patients are tested for Corona and placed in single rooms. In addition, all medical personnel wear an FFP-2 mask when entering patient rooms, even if they have tested negative. We also offer psychological support from our very good psychiatrists, who have been very helpful.
How prepared is the clinic for the so-called "second wave of coronavirus"?
Isner: In order to ensure the care of COVID-19 patients, several wards in the hospital have already been reorganized. In November, the Vivantes Auguste-Viktoria Hospitalwas also reinforced with more staff from the Tempelhof Hospital. Daily conferences are held between the individual COVID-19 wards, including ITS and ER, as well as the management, in order to be able to react to the new events and circumstances at short notice.
You moved to the Vivantes Auguste-Viktoria Hospital, also known in German as "AVK" for short, as chief physician in the „coronavirus year“ 2020 – why?
Isner: The AVK is one of the few hospitals in Berlin with an independent infectious diseases department. It is internationally known for its outstanding quality of treatment for AIDS and HIV, but also for other infectious diseases. The unique cooperation with other disciplines as well as with colleagues in private practice and the Berliner AIDS-Hilfe are also unique. Almost every practicing HIV specialist in Berlin has completed part of his or her residency at the AVK.
What is your main focus?
Isner: Our focus clearly remains HIV/AIDS. Having worked in New York and Los Angeles, I have gained a lot of experience in this field and have been able to learn from the best HIV doctors. The HIV/AIDS epidemic at that time is also a reason why I became an infectiologist. Infectiology as a whole is facing ever greater challenges, not least due to the use of implants, transplants and immunosuppressive therapies. Another focus is therefore on infections that are difficult to treat or diagnose. In addition, we will introduce and further develop antibiotic stewardship in all hospitals at Vivantes.
What does "antibiotic stewardship" (ABS) mean in concrete terms?
Isner: ABS means rational, i.e. prudent, anti-infective therapy in hospitals in order to improve the quality of treatment for patients in the long term and also to reduce multi-resistant pathogens in the long term. Four questions play a decisive role here: Are the antibiotics prescribed indicated at all or can they even be discontinued? Is it even the right one? Is the duration of use correct? Does the dosage make sense? Can a very broad-spectrum antibiotic be replaced by a narrow-spectrum antibiotic? To this end, we conduct, among other things, weekly ABS visits to all intensive care units and wards with high antibiotic use and hold many continuing education courses on individual infectious disease topics.
What can change through such prudent anti-infective therapy?
Isner: By using antibiotics rationally, we can significantly increase treatment quality and patient safety, reduce multiresistance and length of stay in the long term, and reduce nosocomial infections.