Blowing Your Load Whether patients should switch med regimes to keep viral loads undetectable, even though it may worsen their side effects, isn’t actually a scientific controversy, despite your debate that quoted me [“Detectable Rebels,” December 2004]. I would like to add that even with a low viral-load count, HIV replicates and mutations accumulate, causing drug resistance. It is true that people with detectable viral loads aren’t more likely to die in the short term. But the goal is to stay healthy until you’re old. Those taking nonsuppressive regimens due to fear of side effects now will require much more toxic regimens later. Don’t read this article and think of viral replication as a legitimate option, embraced by “cool,” less mainstream doctors. It’s like not replacing worn tires until they’ve blown out on the highway.
Joel E. Gallant, MD Johns Hopkins University School of Medicine Baltimore
I want to add to my comments in your article that the huge pressure to achieve an undetectable viral load does not take individual patients and their daily burdens into account. It also disregards the experience of community care providers who have observed tens of thousands of patients but rarely publish to make their observations widely known. Many physicians, including myself, have patients who have remained stable with detectable viral loads for as long as HIV drugs have existed. The research leadership should respect this experience and design studies to understand the phenomenon. There is often a one-size-fits-all approach to treating HIV. Given the tremendous variation in disease-progression rates, the objective should be to tailor treatments to individuals.
Joseph Sonnabend, MD New York City
Really Cold Mountain Your article on David Randall’s effort to climb Mt. Kilimanjaro sparked my interest because I’m a lifelong climber [“View From the Top,” December 2004]. Even after testing positive 19 years ago, I’ve never stopped. In 1998, an aspiring filmmaker friend asked me to lead a climb up Aconcagua, the Western Hemi-sphere’s highest peak, so he could shoot a film about me and how I still climb, despite my disease. And now I plan to become the first HIVer to climb the highest peak on all seven continents.
Jack Leaven Jackson, Wyoming
Psyched! “Trouble in Mind” [December 2004] will open many eyes to the fact that people, positive or negative, who have schizophrenia, bipolar disorder or drug-induced brain damage are often cast aside. We forget that some of their suffering is a side effect of medications and that living with dementia and extreme depression is a tremendous hardship, especially without appropriate services. If only every community had an individual as dedicated to helping HIVers with mental and emotional issues as Michael Christie, MD. He is a perfect example of compassionate care.
Thomas Stocks Honolulu
Post Haste Now that Arthur Ashe is the first HIVer on a stamp, the second should be Ryan White [“Pushing the Envelope,” December 2004]. It would honor his courage and spirit and make a necessary political statement. The Ryan White CARE Act for funding HIV-related services is our most important AIDS program. After four years without a funding increase, we need a substantial one this year to meet growing demand. And we should all keep a little chunk of Ryan White in our hearts.
Robert L. Reed St. Louis
Stand Up and Jeer In the aftermath of an incredibly disappointing election, I found Walter Armstrong’s letter [“Editor’s Letter,” December 2004] inspiring. I have been involved in HIV-prevention research for nine years, and as a member of the scientific community, I, like Mr. Armstrong, am very troubled by the recent vile actions taken by right-wing ideologues—especially by their brazen disregard for lifesaving, evidence-based prevention strategies. I think Mr. Armstrong’s letter is an important first step in calling people to action. I hope that many are as willing as I am to speak out against these dangerous changes in policy.