The story of Patient 1, in her own words:

Upon arriving  at my HMO for the first time regarding my HIV condition, I came in contact with a general practice doctor who couldn't have been more "pessimistic".  He started out by telling me that the 3-drug-combination does nothing more than prolong life in HIV patients and that the side effects are even worse than AZT.  He said he wasn’t sure of the actual benefits of the these drugs.  He was clearly pushing me not to take them.

As I was listening, I got so depressed and sad at first. But that only lasted for a short time, when I realized what he was trying to do. At first it was very confusing.

I replied, "I read in the newspaper about these drugs, what about people whose virus became undetectable? Is that not correct?"

He changed the subject, shaking his head left and right and said, "Well, you know, some people just choose not to take the medications since that would be a constant reminder of their HIV status, and I can understand that."

"Well, that's not me. I want to help myself and take action."

After some questions about how I was feeling, how long I have known about my HIV, and other common medical questions, he said he would schedule an appointment for me with one of their infectious disease doctors.

He said,  "You know what happens: some people came here and they don’t ask me everything and I don't know what they really want and, by the time they leave, we both still as ourselves, "What did he really mean by that or what do they really want?"

"OK, I will be very clear, I want my health plan to help me pay for these drugs, and I want to continue with my own doctor."

At first he said, "That's not possible." Then he said it wasn't true, it was possible." And basically that is how this ended, and I waited about one month to see the infectious disease doctor.

Here is what happened in that second "interview".

"Hello, I'm doctor S."

"Hi, nice to meet you."

"Why are you here?"

"Well, I'm HIV positive"

"How long have you known?"

"I've know since early 1994."

Meanwhile I told him that I had brought a little history of myself prepared by my doctor, Dr. Robinson.  He said, "OK, good."   So, I handed it to him. 

He started to read, and I noticed that he kind of shook his head with a surprised smile. He said,  "Well, generally I would say if a person is has less than a 10,000 viral load it may not be the time to treat with the combination therapy. If you are 50,000, hey, start immediately."  "I said, my last viral load was above 10,000." It had actually been over 13,000.

He replied:  "Well, your first one was 3800, which is considered low."

I said, "But isn't it the point to take the drugs while you are still healthy?  Why wait until the patient is ill to start treating? I'm not a doctor, but I  read about it and that is the impression I got. I mean, don't I have a better chance to do really well, perhaps even eliminating HIV, if I start the therapy now, instead of a year from now?  It just makes more sense to me, and believe me I don't like to take drugs. I never really wanted to take AZT, nor did my doctor. I was doing well and I guess he didn't think it was necessary at that point to give me that toxic drug for very little or no benefit at all. Now, I understand that the combination therapy is a recent thing, but from my point of view there’s no comparison! In some people they can't detect HIV in their blood, and for that alone it's worth giving it a shot!"

"I understand. If I were in your shoes I would do the same thing. I don't want you to think that I'm limiting your care.  The question at this point is, like I said, the benefits verses the burden to the organism."

"Well, I would do everything in my power to minimize those side effects.  By the way, I heard people are tolerating it well, isn't that true?  I mean, I want you to convince me why I shouldn't take it now."

"Well, I know I can't convince you not to take it.  How do you feel now, do you fell healthy?"

"Oh yes, I feel fine.  Sometimes I have a little tiredness, but it is still to be determined if that is because of the HIV, which I don't believe, or related to some occasional mild depression."

"Well, I can tell you that you wouldn't feel any better upon starting the medication."

"What do you mean?  Physically or emotionally?  Well physically, it may be true, since I already feel great.  But psychologically, I would be feeling much better, knowing that these pills are going into my blood to destroy HIV and infected cells!"

"Well, you know, some people just opt not to take pills, since it would be a constant reminder to them. I actually have some patients who I have been seeing for five years who are not taking anything, and their T cells have remained stable until this date. Your T cells are still pretty much stable."

"Well, I think this is partially true, because beginning about six months ago, you can note a slow decline in my T cell population, so maybe they are not as stable as they were a while ago."

"Well, I know I can't convince you not to take the drugs, but is there a result that would make you perhaps consider not taking the pills?"

"Well, yes, if the viral load is zero"

"Ah ha, well, I don’t think that will be the case, unfortunately."

"I don't think so either."

Then he said, "Let me examine you:  He looked inside my mouth and said,  "No thrush." He also examined my eyes, neck glands, and my stomach area.  He said, "So far so good!"  He said he was going to draw some blood from me in order to better evaluate my case.  He said, "You would need a prescription from me, and you would have to come here periodically for physical and lab exams."

After two-and-a-half weeks I contacted him and he told me that my viral load was 31,000 and he authorized my prescription!

Had this patient gone to her managed care physicians without knowledge of what was the best therapy for her, she would have gotten brushed off by the first doctor, her gatekeeper.

The report she carried enable her to get past the first hurdle to an infectious disease consultant. When she saw that specialist, he also started out by trying to dissuade her from treatment. Reading the report from her personal physician, he reluctantly agreed, that in her shoes he too would want treatment.

Six weeks after initiating triple therapy the patient was feeling fine and her viral load had dropped to undetectable levels.

An open gate. It doesn't have to be very big; it just needs to be open.

Contact DrRobinson@MD-1.com for further information.
Copyright, 1997, American Health Advisory Center

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