HAART – Another chance at Life

Grace was only in her mid-forties, yet AIDS had taken its toll.  When I first met her, she was confined to a hospital bed -her facial bones protruded, eyes sunken, too weak to move.  In fact, she had bedsores over the sacrum and heels.  Those were a product of immobility, as the skeletal bones pressed in one spot for too long, cutting off circulation and forming ulcers.

Grace’s condition was so bad, she only had four CD4 cells left.  These were the ‘troops’ of the immune system.  Most people had at least 1oo times more cells per drop of blood than she had.  Only the very advanced AIDS patients had counts this low.  

I talked to her.  She had not wanted to take medications because she was concerned about side-effects.  But had she tried all the medications?  Clearly she had not.  Her medical doctors were ready to give up.  They wished to start ‘comfort measures’ where she would be given morphine and made comfortable.  She was suffering in her present condition.

I wasn’t ready to give up.  She had a family – a husband, a daughter and a wonderful grandson. I promised to do all I could to help.  I asked the medical doctors to give her one more chance – I would try a new medicine for her HIV that she hadn’t had before.  I would add a protease inhibitor – a powerful antiviral medicine used in conjunction with two other HIV medications.  Effectively this created a one-two-three punch on the virus.  This was called ‘HAART’ or Highly Active Anti Retroviral Therapy, which targeted different points in the viral life cycle. 

All we could do now was wait.  Grace was discharged home, although she was still extremely weak and couldn’t stand.  I was hoping for a miracle.  Ten days later, she came to the outpatient office.  She got up out of a wheelchair and walked a few steps into the exam room.  I was overwhelmed to see that, it took my breath away!  

Over the next few weeks she came into the clinic, visibly getting stronger.  She no longer needed the wheel chair.  The bed sores started to close and finally healed.  Her CD4 cells increased to almost 200.  The virus circulating in her blood was locked away with HAART.                               

That was three years ago and Grace is alive and well today.  I just saw her in the office with her grandson.  It was an important lesson to me as a doctor – to never give up on an AIDS patient, they deserve every chance.  I will always remember Grace’s triumph.

RW

The story of Rose, AIDS survivor

I just had lunch the other day with ‘Rose’, one of my AIDS patients.  It was the greatest thing, to see her – just like a ‘normal’ person. 

Who would believe that just last year, Rose nearly died from a terrible opportunistic infection called ‘Cryptococcus’. 

When Rose came into the hospital, she was thin, wasted and very weak.  She had been having fevers for sometime.  AIDS had been ravaging her immune system and without those defenses, she was extremely susceptible to infection.  Certain types of infections tend to occur in advanced AIDS, and she was now fighting a battle with Cryptococcus neoformans, a nasty fungus.  By the time she came in, this fungus was ‘everywhere’ – it was growing out of her blood. 

We put her on the most powerful medicine we could – amphotericin, or ‘ampho-terrible’.  It was a difficult medicine to take, especially for someone so sick.  Her blood levels dropped to less than half of what they should have been, her electrolytes were profoundly deranged , she felt weak and feverish.  There weren’t any options though – we had no choice but to try and treat her, or face certain death.