Death in slow motion
New reality of HIV emerges as victims live into older age
By Sara Cardine 04/05/2012
Bradley Land may look like an ordinary citizen, but anyone who’s seen the 47-year-old Pasadena resident’s medical records knows otherwise. Spinal meningitis, tuberculosis, osteoporosis and arthritis, neuropathy, hepatitis B and a triple bypass surgery last September are some of the standouts in Land’s long list of chronic health issues.
“I have 26 co-morbidities. I don’t even know them all,” he confesses.
If Land had pen and paper, he could list more, but there’s only one other condition that’s crucial to this story. And, in fact, nearly all his health complications are rooted in it.
Land was infected with HIV at age 17, when AIDS was known as “gay-related immune deficiency” (GRID). Thanks to antiretroviral drug therapy — and his own participation in clinical drug trials that kept him on the forefront of evolving AIDS treatments — he has managed to live an astounding 30 years with a virus once thought to be the deadliest on the planet. His victory, however, has come at a cost, namely his overall health.
America has come a long way in reducing the fatality of AIDS. But while potent drug “cocktails” prevent the virus from replicating, they cannot erase the ravishing long-term effects of the virus on the body and the brain. And, for people like Land, who have been popping 20 to 30 or more pills a day for decades, other serious medical complications, from coronary disease to diabetes, are common.
Science is on the brink of discovering proteins that have attacked HIV in test subjects but has drawn no conclusions on whether the health complaints of long-term patients stem from the virus’ presence in the body or decades-long medical regimens and their resultant side effects. Only now, as survivors reach older ages, are researchers accruing data about the very long-term health risks of living with HIV/AIDS.
“They definitely tend to have diabetes, neuropathy and certain types of cancers,” says Karen Tinsley, program director of Pasadena’s AIDS Service Center, which recently integrated into the city’s Public Health Department to create a one-stop-shop suite of clinical and support services for clients. “We can take care of the HIV, potentially, but maybe not some of the other things that occur.”
For many with HIV, the virus triggers opportunistic diseases that may already have been part of a person’s genetic makeup. These conditions lay latent in the body until the immune system becomes too weak to stave them off. That’s when they attack, explains Land, a longtime AIDS activist who serves on the Los Angeles County Commission on HIV helping advise policies related to treatment, education and prevention programs throughout the county. Despite his title, Land spoke for this story as a private citizen living with AIDS.
“HIV creates the heart problems you may have never had to deal with. You’re going to have to deal with it now,” he says. “If you were a candidate for diabetes, you’re going to have it. You’re going to have these various diseases going on. Managing life, it is now going to change.”
Surviving the onslaught of the HIV virus, its treatment and other co-occurring conditions is a full-time battle for 48-year-old Glendale resident Andres Laguna. He was diagnosed in 2009, after a trip to the hospital for severe stomach pains wound up in a dual diagnosis.
“I had stomach cancer,” Laguna recalls. “They told me the cancer was related to HIV and that I needed chemotherapy. I was so scared.”
Around the time of his diagnosis, Laguna had been managing Type 2 diabetes and underwent therapy for Hepatitis C. The chemotherapy treated the cancer but made his T-cell count drop to dangerous levels, while ongoing liver medications robbed his blood of platelets. After a surgery that removed part of his intestines, Laguna’s blood sugar began to soar to as high as 500, forcing him to switch from simply medicating his diabetes to taking daily insulin injections.
Today, he takes three medications for the HIV, one for blood pressure, one for diabetes, along with insulin, and aspirin to manage headaches and muscle pain. Since being diagnosed, Laguna has lost two jobs — and his employee health benefits — his apartment and his car. Last year, unable to afford medical care, he filed for bankruptcy.
Laguna’s situation exemplifies the new reality of surviving AIDS, from lost jobs and housing to depression and isolation, according to Tinsley. “We forget about the mental health issues can come from living with this illness for a long time.”
That’s something to which Monrovia resident Shasta Foster can personally attest. Diagnosed in 1994, the 63-year-old mother of two has been living with the virus for more than 25 years and admits that mental health is extremely important for those living with a chronic, life-threatening illness. Today, she describes herself as having to deal with the ramifications of AIDS and an early old age.
“It makes an old person of you more quickly,” Foster says. “We lose our immune system, and our body breaks down because of that.”
Foster regularly sees about 15 different doctors and specialists for gastric issues and conditions like skin cancer, asthma and shingles. She has taken as many as 55 pills a day and is a vocal self-advocate. A former escrow manager, Foster, like Land and Laguna, is now permanently disabled. She says she wishes more people knew that AIDS still kills, only now it does so in slow motion.
“Most of my doctors look at me and say, ‘Shasta, you’re not going to die of AIDS,’” she says. “I’ve got a chance — I either get my medications or I die. Those are hard words to say.”
A new outlook
Among those who work in the field of HIV research and treatment, there is a growing optimism that antiretroviral drug therapy will continue to improve, affording patients a longer lifespan. Just how healthy that lifespan will be, however, is uncertain and partly up to them.
Dr. Judith Currier is a professor of medicine and chief of the Division of Infectious Diseases at UCLA, where she does clinical work and sees HIV clients in the outpatient clinic. A person’s prognosis has a lot to do with his or her own genetic predisposition toward certain chronic conditions, she says. Some may take antiretroviral drugs for decades and present few problems, while others are more susceptible to illness stemming from the virus or the side effects of treatment.
That longer term chronic effects are now being reported and researched is a testament to the overall success of antiretroviral drug treatment, Currier says.
“It’s a reflection of how good our treatments are,” she adds. “There is no question in anybody’s mind that the disease is worse than the treatment.”
Currier says an individual’s outcome depends on three components — how their body responds to the treatment, how they react to medications and behaviors such as smoking, diet and exercise or medication compliance contribute to their overall outlook.
Compared to where America has been, the future of HIV prevention and treatment is bright. It’s somewhat of a victory for pioneers like Land, who still actively advocate for better, more comprehensive health coverage and ending the stigma of contraction.
“I’m so fortunate to be alive. I feel like I’ve beat the odds and there are people who really love me,” says Land. “Love moves mountains.”