One of the great things about treating people with HIV is the sense of being in a fight together against this wily adversary. We analyze and make decisions together; some people read all the latest studies. But even the most informed sometimes say, “You’re the doctor—you tell me.”
Sarah, 35, positive since the late ’80s, is a health professional herself. She tracks her labs and calls me with observations and questions.
As 2005’s ads promised simpler regimens, Sarah was still gulping mountains of pills. We’d gone back and forth about changing her combo, hesitant to fix what wasn’t broken.
But now her tests showed liver problems and a rising viral load. We usually delve into details, so at our next visit I began listing options, voicing my own uncertainty. Looking up from my ruminations, I saw her large brown eyes pooling with concern. “Doctor, I’m getting scared,” she said.
It was time for me to take the weight off her shoulders. “OK, here’s what I think we should do,” I said, and she sighed in relief. Along with encouraging them to know as much as possible, we sometimes have to allow our patients their lives and priorities beyond the virus.
I suggested a new combo with one extra drug for insurance. And it’s sweet triumph for both of us when we get her next labs: better liver tests, CD4s at mid-600s, viral load under 50.
