Saturday, February 25, 2012

The AIDS Alphabet: P is for PCP, PICC Lines and PIs

The AIDS Alphabet: P is for PCP, Pentamidine. PICC Lines and PIs

PCP: Pneumocystis carinii pneumonia (most recent name is pneumonia jiroveci) is a lung infection commonly seen in people with compromised immune system. PCP, otherwise known as AIDS pneumonia, usually occurs in patients with a T cell count below 200. As in the case of CMV (cytomegalovirus), the organism that causes PCP can enter the healthy human body and live peacefully in it for the rest of its life, not causing any damages. Only when the immune system weakens or deteriorates, the organism activates and can cause pneumonia. In the early days of AIDS, PCP was too often a regular cause of AIDS related death for AIDS patients. Medications used for treatment of PCP include: Bactrim, Pentamidine, Mepron (Atovaquone), and Primaquine.

Pentamidine: It is used to prevent and treat PCP usually when the patient becomes allergic to the more commonly used antibiotic, Bactrim. Pentamidine is available in inhalation (for PCP prevention) and injection, or intravenous (for PCP treatment). 

Protease Inhibitors: Protease Inhibitors, or PIs, inhibit replication of HIV protease, which is an enzyme needed for formation and assembly of HIV proteins. An example of PI is indinavir (Crixivan).

PCP, aka pneumocystic carinii pneumonia, pneumonia jiroveci or just AIDS pneumonia, made its presents in the U.S. in a handful of young male individuals who died in a matter of days. PCP was the first sign that AIDS had arrived to the States. As with other AIDS-related opportunistic infections (OIs), the life-extending HAART medications can prevent patients' immune system to weaken to the point where OIs like PCP, KS, CMV can become active. Still, lately it seems that KS and PCP have resurfaced.

AIDS pneumonia, an opportunistic infection associated with a depressed immune system (like in patients with AIDS) has become a focus point and main "character" in photographs, playwrights, books and movies featuring the pandemic. One example is Angels in America, the HBO movie.
Angel in Central Park:Lensbaby Photography, part of the AIDS Museum collection

What it's like to live with (or better said to survive) PCP? Just ask Kurt Weston. He survived three bouts of PCP and is still here to tell the story. And he does, in Journeys Through Darkness--A Biography of AIDS.

Award-winning photographer Kurt Weston's first bout of AIDS pneumonia: excerpt from Journeys third chapter--Dark Angel, named after one of my favorite Kurt Weston images.

As always,  thanks for visiting,
Alina Oswald
Author of Journeys Through Darkness: A Biography of AIDS

with Dark Angel
During his first hospitalization with pneumonia, doctors placed Weston in an isolation ward, which was a common procedure for dealing with AIDS patients, to prevent the disease from being spread, because at the time experts were not sure of all the ways it could be transmitted. When it came to HIV/AIDS, in order to follow hospital rules, both medical professionals and visitors had to go through two separate doors and a ventilation system to enter the patient’s room.
    Kurt Weston woke up hooked to tubes and machines, not sure what was happening to him. He opened his eyes only to realize that people wearing masks, gloves and suits were staring down at him.

    During his hospitalization, doctors started him on intravenous Bactrim, a full-spectrum antibiotic used to treat PCP. The treatment started to work and a few days later Kurt began feeling better, well enough to sit in his bed with the IV medication dripping in his arm and watch the news on TV. That’s how he learned that Queen’s lead singer, Freddie Mercury, had just died of AIDS-related causes.
    Unlike Mercury (who died of AIDS-related causes on November 24, 1991), Kurt Weston is still alive. The visual artist has survived his first bout of PCP and two others that followed. His doctor released Kurt two weeks later with a list of medications he needed to take as maintenance treatment and with a six-months-to-live prognosis.
    Like Mercury, Kurt Weston was forced to keep his disease a secret, at the time. Kurt’s physician advised him that the best thing for him to do was to continue taking his medication as prescribed and go back to work. He also advised Kurt not to mention to anybody at Pivot Point about his diagnosis, in order to avoid the stigma associated with the disease, because, the physician added, “people wouldn’t understand [the AIDS situation].”
    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.
    In 1987 the FDA approved the first anti-HIV medication, azidothymidine [AZT], which had powerful negative side effects. While the drug was suppressing the replication of HIV, it was also causing bone marrow suppression that could lead to anemia, hair loss or a decrease in white blood cells. Other side effects included nausea, muscle weakness, and headaches. But AZT was the first AIDS medication to offer patients a sliver of hope for survival, no matter how slim that was. So Kurt had no choice but to take the drug if he wanted a chance to stay alive.
    AZT made him extremely fatigued, to the point that Kurt started to find it more and more difficult to maintain the high energy level he needed to sustain at his job. As a fashion photographer he had to work with many people, from hair stylists and make-up artists to fashion designers, who were looking up to him to make decisions. It was his job to keep them motivated and enthusiastic in the studio, but in order to do that Kurt needed to be energetic and enthusiastic himself. And all he wanted to do was crawl up in a corner, somewhere where everybody would just let him be with his fatigue, nausea, and sickness.

    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.
    By then, a new AIDS pneumonia drug, Mepron, was becoming available. Since 1991 Mepron has been approved for treatment of mild to moderate cases of PCP in patients who cannot tolerate standard treatments. Yet, when it became available, Mepron was only recommended for acute cases of PCP and doctors were not sure if it worked as prophylaxis. Besides, there were no instructions or guidelines regarding how to administer the drug; therefore doctors had no choice but to experiment with it and guess on the prophylaxis doses.
    Kurt started to take a third of what was a regular dose of Mepron. Unfortunately it didn’t work as expected and a couple of months later he ended up back in the hospital with yet another bout of pneumonia.

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