The Observer, December 8, 2006
Volume XXXIX, Issue 13
Reality behind HIV treatments uncovered
Halima Grant, mother of two, HIV-positive for 17 years, found out she was HIV-positive about the time Magic Johnson discovered he was HIV-positive. She's not rich, famous and wealthy, like Magic Johnson: her reaction to the diagnosis was to try killing herself with drugs and alcohol. But today, she's doing better. She's been on therapy for a long time, and like Magic Johnson, looks healthy, and largely feels healthy too.
HIV medicine today isn't as noxious as it was twenty years ago. And yet, the regimen is still toxic. A friend of mine who recently had her own experience with the toxic nature of those drugs is a first-year resident at a large hospital.
One afternoon, she'd been accidentally stuck with a used syringe from a patient she'd treated a few times. She took off her gloves, walked to the call room, and cried: she knew the patient was HIV-positive, and had been treated for a while. With prophylactic treatment, her chances of contracting the virus were low, but she would have to take a month-long regimen of HIV medications as a prophylactic measure.
It took over my friend's life. She was constantly nauseous and her bowels became rebellious. One time, stuck in traffic, she vomited at the steering wheel. She began timing the drugs so that the diarrhea wouldn't interfere with her day – if she took it in the middle of the night, she could sleep through the worst of it. The worst, though, was the taste of the crixavan: a taste she described as the metallic taste of glue. She popped mints constantly, but as soon as the tic-tac dissolved into sugar particles, the taste came back – and with her stomach upset, she received an unpleasant reminder of the taste with every burp. The last few days of her treatment, she had a vertigo attack.
The first month or two is hard, says Grant, but once the body adjusts to the toxic treatment, it's difficult not to take them. The drugs are much less toxic than they were in the 80's, and not taking them leads to worse: for Grant, not taking her medications means she can't move, can't get up, loses weight, and develops swollen lymph nodes.
Conversations like these remind me to check my assumptions: someone who looks healthy may be in fact defined by their illness. Just because the drugs are available for a disease doesn't mean that the treatment isn't wearing, or sometimes difficult.
Listening to these stories reminds me that comprehensive prevention for HIV and other sexually transmitted diseases is important. "Young people think they're living longer. They think, I'll take this pill and I'll be OK. But you won't be OK, you're on that med the rest of your life. If you miss [it], you might die, you might get very very sick. You shouldn't want to live like that," Grant said.
My friend, as a resident, came away with sobering insight what her future patients might experience in their first months of HIV treatment. She told me half-seriously, "I think all physicians should have to go through this – I didn't realize it was going to be so hard."
In the meantime, the best that those of us interested in medicine can do is to learn to listen.
Liu is a MD/PhD student in health policy.
