SEX AND THE SUBURBS
The failure of my first drug combination has remarkable
parallels to the failure of my first marriage. Feelings of anger, betrayal
and disbelief mingle uncannily with a sense that somehow it was all my fault.
This time, however, the fruit of the relationship isn’t two extraordinary
children, but two mutated drug resistant strains of the virus. Not quite the
insurance policies for my old age like the other two, I fear.
HIV treatment is for life, not just for Christmas. You shouldn’t ditch
it at Battersea Dogs’ Home when it proves not to be so alluringly cute
as first hoped. I anticipated a long and fruitful relationship as I strolled
down the aisle with my first combination of Combivir and efavirenz. I’d
picked this combination after scrutinizing the alternatives with military
precision, and to be honest, the two years we had together were great. My
viral load became undetectable after a couple of months and my CD4 count blossomed.
While others were driven to lunacy by their drugs, I experienced few side
effects, beyond the occasional efavirenz-induced Saddam Hussein sex dream
(he was extraordinarily skilful for an evil dictator). I certainly didn’t
expect it to fail so quickly, taking the whole class of NNRTIs away at the
same time.
The first indication things were going askew came during the eighth month
of my pregnancy, when my viral load inexplicably became slightly detectable
for the first time in two years. Initially considered to be a “blip”
somehow related to my pregnancy, it seemed unlikely that I could have developed
resistance. I considered myself adherent - I never missed doses and was only
occasionally late with taking my medication. Resistance was something that
happened only to other naughty, chaotic people, laissez faire about their
medication, I erroneously believed. When I received the call from my doctor
telling me that I had developed resistance to 3TC as well as to efavirenz
(and consequently all other drugs in that class), my complacency crumbled.
No one seems certain why it happened. No doubt there will be some who will
sanctimoniously point the finger of blame my way: my adherence could not have
been good enough, despite my protestations. I’m lucky enough to have
a wonderfully supportive doctor who seems to believe me and has fought my
corner. Perhaps developing resistance was somehow related to my pregnancy,
resulting in me absorbing incorrect levels of the drugs. Perhaps it just happens
to some unfortunate bastards.
Losing a combination is a little like losing a supportive and unassuming partner:
you don’t realise how good you had it until it packs its bags and moves
out of your life...forever. I took for granted the low pill burden and absence
of food restrictions. Suddenly I’m faced with a handful of strange new
drugs that have to be taken with ‘a light snack’ and ‘food’.
It’s somewhat baffling trying to have a snack with my food, whilst juggling
the care of three children, a constant metallic taste in my mouth and surreptitiously
necking a plethora of pills, including one so large I’m convinced it
should be shoved up my ass, not down my throat. I’m told I may turn
yellow as a result of my new combination and to be honest that colour just
isn’t in this season. Each morning I rush to the mirror expecting to
be a brighter shade of yellow than Marge Simpson; and to have developed fat
gain and loss topped off with a matching pair of exploded kidneys. So far
none of my fears have been realised, but it has been just one day on my new
combination, so who can tell.
So how about the bright side? Well I did manage not to bugger up the AZT in
my previous combination. I’m fortunate enough to live in a country where
you do get other options if you balls-up your first combination. I’ve
picked something that doesn’t seem too horrendously toxic or complex.
Perhaps entering into my second combination is a bit like entering into my
second (ex) marriage. I’m walking down the aisle determined not to make
the same mistakes I made the first time, but this time without the blind optimism
that it will last forever.
