Monday, October 10, 2011

Thirty Years of AIDS: Continuing the AIDS Alphabet - Bactrim

In a previous post I mentioned the importance of knowing the AIDS alphabet.

A stands for AIDS, AZT and antiretroviral (ARV) medications, even ART (short for HAART, pronounced like "heart" the so-called AIDS cocktail, the medications introduced by Dr. Ho in the mid-nineties and what had a Lazarus effect on AIDS patients, bringing them back to life (active life) from the brink of death)

B stands for Bactrim (let's just stay with Bactrim for now). I'd like to share what I've learned about it while researching and writing Kurt Weston's, an award-winning legally blind photographer, story Journeys Through Darkness. Hope you'll enjoy the read and find it informational.

As always, thanks for visiting!
Alina Oswald
Author of Journeys Through Darkness

Bactrim: Bactrim is a wide-spectrum antibiotic and the most common medication used in treating PCP. It comes as an injection (IV) for acute cases of PCP and as tablets for maintenance and prevention treatments. One major side effect is that patients can become allergic to Bactrim and, therefore, forced to try other, sometimes less effective, PCP medications. Patients can be desensitized back to Bactrim, in pediatric (small) doses.
[...]
Once out of the hospital, Kurt followed the doctor’s advice and took his medication—Bactrim tablets—to keep his pneumonia in check. He was also eager to resume whatever normality of life and career were possible. Yet, the process was a long and strenuous one, partly due to the virus ravaging his body and partly to the side effects to the very medication supposed to keep him alive.
[...]
While Bactrim was an effective medication for keeping PCP in check, it wasn’t unusual for patients to become allergic to it. When that happened, doctors tried to give patients other medications, but too often the results were not as effective.
Halfway into his treatment, Kurt experienced an allergic reaction manifested through rashes and fever. He became allergic to Bactrim and his doctor had no choice but to take him off the drug and switch him to something else. Kurt ended up trying several other medications, as the physician was trying to find one that would work at least as good as the Bactrim initially did.
One of the PCP prophylaxis treatments the doctor tried on Weston was pentamidine. The medication could be administered intravenously, intramuscularly (both used today to treat acute cases of PCP), or inhaled as an aerosol, which was later approved as PCP prophylaxis treatment. 
While the intravenous pentamidine could cause severe pancreatitis, Kurt’s doctor decided to start him on the aerosolized version and administer the medication as a fine mist the patient had to inhale. Kurt had to sit at a “machine” and breath in the mist containing the medications. He was doing this during his lunch breaks. But despite his doctor’s high hopes, the treatment didn’t work. The photographer ended up in the hospital, again, with a second bout of PCP.
Around that time, the photographer started putting his time and energy into reading as much as he possibly could about the disease, trying to find a way to survive it. That’s how he came upon a San Francisco publication called BETA. The Bulletin Experimental Treatment for AIDS published an article that explained how patients could be desensitized, or adapted, back to Bactrim, while restarting them on the medication in small, pediatric doses. Excited about the new possibility, Kurt shared the news with his physician and begged him to try the procedure on him. But the HIV specialist thought the procedure was too risky.
In retrospect, the photographer believes today that any doctor would have reacted the same way because there was just not enough information about AIDS to allow these kinds of risky decisions from medical professionals. But that didn’t mean that doctors gave up on their AIDS patients.
Several drug combinations later, Kurt’s physician still couldn’t find something that would work effectively on his patient. And it wasn’t long until the doctor slowly started to run out of options when it came to finding new available medications that could keep his patient’s AIDS pneumonia in check. He had one more choice left to help treat Kurt’s PCP. That was intravenous pentamidine, a drug that could cause serious side effects and could increase the chances of developing pancreatitis. But the doctor tried it on Kurt and the treatment eventually worked and helped the photographer get over his third bout of PCP.  
Out of the hospital for the third time, Kurt and his doctor had, again, to decide on a prophylaxis treatment. And again, Kurt pleaded with his doctor to desensitize him to Bactrim. This time the doctor agreed to it. The procedure worked and Kurt won another small, yet important battle with his AIDS.
By then, though, he had only three T cells left. Today, almost two decades into his living with AIDS, when talking to students about HIV/AIDS as a Positively Speaking volunteer, Kurt Weston calls his three T cells “the Three Stooges: Moe, Curly, and Larry.”