May #47 : The Way We Live Now: Michael Saag

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A POZ Family Album

POZ 5TH Anniversary Issue: Year One

POZ 5TH Anniversary Issue: Year Two

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The Way We Live Now

The Way We Live Now: Andrew Sullivan

The Way We Live Now: Jocelyn Elders

The Way We Live Now: Mary Lucey

The Way We Live Now: Rafael Campo

The Way We Live Now: Mathilde Krim

The Way We Live Now: Mario Cooper

The Way We Live Now: Richard Goldstein

The Way We Live Now: Phill Wilson

The Way We Live Now: Michael Saag

The Way We Live Now: David Ho

The Way We Live Now: Jon Kaiser

The Way We Live Now: Sarah Schulman

The Way We Live Now: Judy Greenspan

The Way We Live Now: Eric Rofes & Dan Savage

The Way We Live Now: Kaiya Montaocean

The Way We Live Now: Ashok Row Kavi

The Way We Live Now: Pat Califia

The Way We Live Now: Asia Russell & Julie Davids

The Way We Live Now: Dennis DeLeon

The Way We Live Now: Jason Farrell

The Way We Live Now: Pernessa Seele

Honeymoon to HAARTache

Monkey Business

S.O.S.

When Plagues Return

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Saint Sorge

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Get Over It

Rubdown Lowdown

The Berlin Stories

T-20, Coming to a Combo Near You

Pill Drill

Suck in Your Gut

Put the Gart Before the Course

Where to Find It

The Skinny on Lipo

HAART Chart

The Road to Wellville

IN MEMORIAM



Most Popular Lessons

The HIV Life Cycle

Shingles

Herpes Simplex Virus

Syphilis & Neurosyphilis

Treatments for Opportunistic Infections (OIs)

What is AIDS & HIV?

Hepatitis & HIV


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May 1999

The Way We Live Now: Michael Saag

Doctor, Researcher

The treatment of HIV disease has always been a roller-coaster ride. Clearly, the direction since the release of protease inhibitors has been upward. But I have a sense that we're heading downhill fast. HAART is failing more and more people, and it's folly to think that the return of the virus in the blood will not ultimately cause sickness and death.

I first noticed this trend last spring, when two clinic staff members asked for grief counseling. I started looking at the numbers of deaths of patients here (all treated for several years), and saw that they had gone up significantly. The strange thing is, I'm not sure why these patients are dying. Often, they just go into wasting for unknown reasons. And many deaths now are caused by liver failure. From Hepatitis C? Drug toxicity? HIV itself? We don't know. In retrospect, it was unrealistic to believe that the vast majority of patients on HAART would maintain undetectable viral loads forever, amen. Today, when starting a patient on HAART, clinicians should have a game plan for what happens when this first regimen fails. If we aren't preparing our patients for failure, we're doing them a disservice.

I'm critical of AIDS researchers (myself included) for implying we knew the answers after just a few years of using these drugs. All of us need to be humble in the face of our vast ignorance. We must commit to respect—and aggressively address—the unknown.




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