Saturday, October 29, 2011

30 Years of AIDS: The AIDS Alphabet - E is for Entry Inhibitors

30 Years of AIDS: Learning the AIDS Alphabet--E Is for Entry Inhibitors

Angel in Central Park, by Alina Oswald
Over the last 30 years, AIDS patients have tried various medications that could keep them alive and a step ahead of the disease. One of the warriors, at war with their AIDS, is best-selling author of Signals and Hope, Joel Rothschild. To find out more about his story and his life (including his life taking medications known as entry inhibitors, please read my article "Scratching the Surface of the Divine," originally published by A&U Magazine - America's AIDS Magazine. Award-winning photographer Kurt Weston is another AIDS warrior who also talked to me about his life with AIDS and with medications (including entry inhibitors like Fuzeon) designed to keep him ahead of the disease. I'd like to share with you a short excerpt from Journeys Through Darkness, a biography of Weston's life and artwork, that talks about entry inhibitors.

Entry Inhibitors: The role of entry inhibitor medications is to keep HIV from entering the T cell. One example of entry inhibitor is Fuzeon (T20), available only as an injection administered under the skin, usually twice a day. Other entry inhibitors include selzentry/Maraviroc and Vicriviroc.

In 2003, FDA approved a medication called Fuzeon (or T20) supposed to fight HIV by not allowing the virus to enter the T cell. Because it is difficult to manufacture, the drug is extremely expensive and available only as an injection. Studies have shown that AIDS patients who are on Fuzeon may get skin rashes where they self-administer the shots, or some may become more prone to developing pneumonia.
While on Fuzeon, Kurt has experienced very few side effects and he liked that very much. Also, to make best use of the medication and his time, he had no choice but to quickly learn how to integrate his shots into his daily schedule.
Ever since his diagnosis, AIDS has been a constant variable in the equation that describes Kurt Weston’s existence. In time and with the appearance of new treatments, the threat of his disease has turned from immediate to manageable. These days, AIDS has become more of a constant companion in his life rather than a threat, but it continues to influence, at least partly, all decisions, minor and major alike, that he has to make—be they related to his studies, to traveling or eating his meals. 
   In general, some medications have to be taken with food, while others before or after meals at precise times each day, several times throughout the day, for the rest of the AIDS patient’s life. For this reason, people living with the virus and on such medications always have to take their treatments into consideration when planning their daily activities.
On mornings when he had to make it to school early, Kurt made sure to get all his medications ready the previous night before going to sleep. He lined up all his pills so they would be ready for him to grab on his way out the door the following morning.
But pills are only a small part of Kurt’s treatment. He also has to give himself daily injections.
To be able to self-administer the Fuzeon, he first has to prepare the fluid—that is to put sterile water in the Fuzeon vial and get it hydrated. Then he would store the container in the refrigerator until he’s ready to use it, which should be within twenty-four hours. The daily two Fuzeon shots have minimum side effects on Kurt, but, on the other hand, they’re also “a pain in the ass,” as he calls them, because they require a lot of knowledge, work, patience, and time. And Kurt has to deal with these treatments and medications every single day, no matter how busy or fast pace his day may be.
For a while, Kurt was also taking a trial medication supposed to reduce his lipodystrophy (or body fat mal-distribution), which is a side effect to some HAART regimens. This was a new and experimental drug supposed to keep his fat from accumulating in all the wrong places. Therefore, every single day, after getting his first medication started, he had to take his first dose of pills, and then start hydrating his second, trial medication. Kurt had to self-administer two vials of this medication, daily, in order to see any results. For a while it seemed to work nicely and he started losing his P.I. belly. He also learned to wear clothes that would hide whatever was left of it… Eventually, Kurt had to stop taking the trial medication because of its various side effects.
Medication also interferes with patients’ traveling schedules. Kurt Weston avoids being away from home for longer than a week, partly because he doesn’t have enough room in his suitcase to carry medication for more than six or seven days at a time. When he travels, the photographer has to bring with him the Fuzeon kits containing the syringes, alcohol swabs, medications, sterile water and all the vials with the actual medication. He has to pack them so that they don’t break or get damaged in any way, and then pray to God that at the airport nobody stops him to ask why he’s carrying all those syringes and vials with him.
The entire process is a hassle, but Weston prefers it to taking lots of pills that give him lots of negative and powerful side effects. With the Fuzeon injections, he only experiences a hard tiny bump at the place where he administers the injection, and only because it takes awhile for the drug to disperse from under his skin. But to take a drug whose only problem is that it has to be injected is not a big deal for Weston. He has been on other drugs that gave him all kinds of “unpleasant” side effects.