- Email: [email protected]
Undetectable viral load in AIDS patients
Letter to the Editor
Undetectable Viral Load in AIDS Patients* Having spent the last several years as a nursing professional volunteering with AIDS patients, I have come to understand a little of the struggle these individuals face. I will tell you a bit of a success story about a person I'll identify as "Chris." For several important reasons, Chris feels his story should be told. First, he wants to credit his parents, brother, sister, and a head nurse for their support since he was diagnosed with AIDS in February 1995. Second, he wants to acknowledge the work of the physicians, nurses, researchers, and public and private funding organizations who have brought outstanding advances to the present-day treatment of AIDS. Finally, Chris wants to offer hope to the countless number of men and women afflicted with AIDS. Chris dated women in college and at one time was even engaged. Chris broke his engagement after telling his fiancee of his sexual orientation. During his college years, he became increasingly aware of his sexual orientation--bisexual for a period and homosexual for more than 20 years. He was promiscuous and never used condoms. Chris went on to pursue a successful career in interior design. In November 1994, Chris was hospitalized with a non-PCP pneumonia. He had never been sick before but couldn't seem to "shake" this infection. After more deliberate testing, Chris was diagnosed in February 1995 with AIDS (CD4 under 200). His doctors told him he would die and also told his family to plan accordingly. Clads went to a nursing home to die worrying about death and burial. His family and head nurse repeatedly told him they would take care of the burial and worry about dying; he was to think about getting well. In February 1995, Chris was started on AZT, a treatment that made him seriously ill. After several hospitalizations for severe anemia, dehydra*To protect this client's anonymity the author has asked that only her initials and state be published.
tion, and as many as four transfusions of whole blood, it was determined in October 1995 that he was allergic to AZT. The treatment plan was changed and Chris was started on 3TC and d4T. In June 1996, Chris was accepted as a client in the National AIDS Treatment Advocacy Project (NATAP) and began a regimen using protease inhibitors. Chris's first protocol included ritonavir, 3TC, and d4T. In January 1997, peripheral neuropathies indicated yet another change in treatment. At this time, a lowered dosage of ritonavir coupled with saquinavir and 3TC was initiated. The first news of an undetectable viral load (down from 33,000 in June 1996) and a CD4 count of 409 (up from 198 in June 1996) came in February 1997. Chris called his parents as he has done every week, but this time it wasn't his usual weekend call. His father's f'wst response was "What's wrong? It's not the weekend." Chris related the good news and almost immediately his mother was also on the line sharing Chris's elation. Chris has a new lease on life and continues to feel great. He wants to get his life back together and work in art and design and travel to Europe to study architecture. In other words, HE WANTS TO LIVE! Chris's physician stated that resuits of the proteaseprotease clinical trials are cautiously optimistic. He reports undetectable viral loads as high as 80% in clients who are recently diagnosed with HIV and have not had extensive early treatment with other protocols. It is absolutely essential that the client follow the NATAP compliance manual Protease Inhibitor Users Guide: How to Maximize the Benefit of Protease Inhibitors. This booklet stresses the importance of hydration, nutrition, drug interactions, side effects, and the significance of taking the medications on a very strict schedule. Clients who have been pretreated seem to be achieving 40% success rates on the proteaseprotease therapies. Additionally, 10% to 20% failure rates were reported by Chris's physician.
JOURNAL OF THE ASSOCIATION OF NURSES IN AIDS CARE, Voi. 9, No. 1, January/February 1998, 84-85 Copyright 9 1998 Association of Nurses in AIDS Care
Letter to the Editor 85 Questions remain. Will these new therapies continue to be effective? Will the HIV virus become resistant and/or cross resistant? Will the medications be available to those who need them? How will clients be able to afford long-term treatment? Who rations health care for these clients? Will clients be able to live and even work without drug therapy? Funding for these drugs remains a major issue. For example, Chris's medication costs more than $24,000 a year, yet if he were to join the workforce and earn
more than $15,700, he would not qualify for state funding for this medication. Additionally, the Social Security Administration would likely deny disability payments to clients such as Chris who have undetectable viral loads.
J.C~ Illinois
Undetectable Viral Load in AIDS Patients* Having spent the last several years as a nursing professional volunteering with AIDS patients, I have come to understand a little of the struggle these individuals face. I will tell you a bit of a success story about a person I'll identify as "Chris." For several important reasons, Chris feels his story should be told. First, he wants to credit his parents, brother, sister, and a head nurse for their support since he was diagnosed with AIDS in February 1995. Second, he wants to acknowledge the work of the physicians, nurses, researchers, and public and private funding organizations who have brought outstanding advances to the present-day treatment of AIDS. Finally, Chris wants to offer hope to the countless number of men and women afflicted with AIDS. Chris dated women in college and at one time was even engaged. Chris broke his engagement after telling his fiancee of his sexual orientation. During his college years, he became increasingly aware of his sexual orientation--bisexual for a period and homosexual for more than 20 years. He was promiscuous and never used condoms. Chris went on to pursue a successful career in interior design. In November 1994, Chris was hospitalized with a non-PCP pneumonia. He had never been sick before but couldn't seem to "shake" this infection. After more deliberate testing, Chris was diagnosed in February 1995 with AIDS (CD4 under 200). His doctors told him he would die and also told his family to plan accordingly. Clads went to a nursing home to die worrying about death and burial. His family and head nurse repeatedly told him they would take care of the burial and worry about dying; he was to think about getting well. In February 1995, Chris was started on AZT, a treatment that made him seriously ill. After several hospitalizations for severe anemia, dehydra*To protect this client's anonymity the author has asked that only her initials and state be published.
tion, and as many as four transfusions of whole blood, it was determined in October 1995 that he was allergic to AZT. The treatment plan was changed and Chris was started on 3TC and d4T. In June 1996, Chris was accepted as a client in the National AIDS Treatment Advocacy Project (NATAP) and began a regimen using protease inhibitors. Chris's first protocol included ritonavir, 3TC, and d4T. In January 1997, peripheral neuropathies indicated yet another change in treatment. At this time, a lowered dosage of ritonavir coupled with saquinavir and 3TC was initiated. The first news of an undetectable viral load (down from 33,000 in June 1996) and a CD4 count of 409 (up from 198 in June 1996) came in February 1997. Chris called his parents as he has done every week, but this time it wasn't his usual weekend call. His father's f'wst response was "What's wrong? It's not the weekend." Chris related the good news and almost immediately his mother was also on the line sharing Chris's elation. Chris has a new lease on life and continues to feel great. He wants to get his life back together and work in art and design and travel to Europe to study architecture. In other words, HE WANTS TO LIVE! Chris's physician stated that resuits of the proteaseprotease clinical trials are cautiously optimistic. He reports undetectable viral loads as high as 80% in clients who are recently diagnosed with HIV and have not had extensive early treatment with other protocols. It is absolutely essential that the client follow the NATAP compliance manual Protease Inhibitor Users Guide: How to Maximize the Benefit of Protease Inhibitors. This booklet stresses the importance of hydration, nutrition, drug interactions, side effects, and the significance of taking the medications on a very strict schedule. Clients who have been pretreated seem to be achieving 40% success rates on the proteaseprotease therapies. Additionally, 10% to 20% failure rates were reported by Chris's physician.
JOURNAL OF THE ASSOCIATION OF NURSES IN AIDS CARE, Voi. 9, No. 1, January/February 1998, 84-85 Copyright 9 1998 Association of Nurses in AIDS Care
Letter to the Editor 85 Questions remain. Will these new therapies continue to be effective? Will the HIV virus become resistant and/or cross resistant? Will the medications be available to those who need them? How will clients be able to afford long-term treatment? Who rations health care for these clients? Will clients be able to live and even work without drug therapy? Funding for these drugs remains a major issue. For example, Chris's medication costs more than $24,000 a year, yet if he were to join the workforce and earn
more than $15,700, he would not qualify for state funding for this medication. Additionally, the Social Security Administration would likely deny disability payments to clients such as Chris who have undetectable viral loads.
J.C~ Illinois