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Ever considered a ‘drug holiday’? (No, not the William Burroughs kind.) Ian Price took five months off his antiretroviral routine for a recent trip to the US. The holiday was great but going back on the pills not so easy
A long holiday abroad can be a very stressful experience. It can also be made worse if the country you wish to travel to puts restrictions on visitors. This was the situation for my partner and myself late last year. We both wanted to visit the US, but as I was taking anti-HIV medication, how was I to arrange to get my pills into the US and not risk being sent back, leaving him all alone in California?
After much thought about the pros and cons of smuggling, posting or buying the pills in the US, I decided to ask my doctor what he thought about a ‘drug holiday’.
At this time, I had been taking the pills for four years. My viral load was undetectable and my CD4 count had risen from 280 to almost 700. My doctor thought my suggestion of a holiday away from the drugs a perfectly reasonable idea. He even said that if I were presenting today with the blood results I had four years ago, I would not be put on therapy.
After the initial shock of being told by my clinician that he was perfectly happy for me to give up the pills, we discussed some practical points. In the light of what happened they were very sensible.
I was told to stop taking the treatment several months before the date of departure. This would allow my body, which had taken four years to get used to daily doses of combivir and efavirenz, to get rid of all the chemicals and avoid any possibility of an adverse reaction to withdrawal from the medication. Similarly, for someone who had full medically-induced viral suppression for an extended period, stopping the pills would certainly lead to a rebound of the viral load, and this might be accompanied by a second sero-conversion-like illness. It would not be a good idea to risk this sero-conversion illness on the eve of departure or during an expensive holiday. Better beforehand.
I did get a second sero-conversion illness, which resulted in me having to take time off from work. Happily, it was not as awful as the first sero-conversion that laid me out for weeks many years ago. But it was still pretty bad with muscle aches, terrible headaches and neuropathy of the legs. Still, it was all over well before the departure for Los Angeles.
The strangest part about giving up the pills was my own psychological response. Having had the mantra of adherence drilled into me for years, “you must take the pills at the same time each and everyday, or...”, I found that I was getting serious pangs of guilt about not taking them; pangs of conscience that were making me almost physically sick. Well, there is something for the therapists to think about!
As for the holiday, it was great. We went to San Francisco, which was my first visit since 1983. I have to say I was disappointed. There was none of the vibrancy and excitement of what I remember. But then not only is SF 20 years older, so am I, with 20 years of accumulated emotional baggage. The ‘gay’ neighborhood was dismal - just like any other American neighborhood, except there are rainbow flags everywhere you looked.
The Grand Canyon was ...What can one say!
Las Vegas was one of the cities of the plain; you were just waiting for the fire and brimstone to arrive as part of a show staged by one of the bigger hotels. Great to see it all: the spectacle, the squalor and the sleaze.
But on my return to London and the Kobler clinic after three weeks of excess, I was saddened to learn that my CD4 count was 230 and my viral load was 300,000.
These results only got worse over the next couple of weeks and my clinician put on his gravest face and told me that I had to think about re-starting therapy. I have to say I half expected this and was not imagining that I would be able to give up the pills permanently.
Although the break of five months was better than nothing, and did allow me to get away from the daily ritual of pill popping, it was long enough to have forgotten the bad points.
Interestingly, having restarted the pills, I am now experiencing all the side
effects that I first came across over four years ago, in a slightly less intense
way. The effect of the first dose of efavirenz when I restarted almost made
me faint, and the way it affects your sense of balance was something I had
forgotten about. Apart from the psychological effects of the efavirenz, the
nausea and gastro-intestinal problems have all come back, though they seem
to be finally fading slowly after four to five weeks of renewed therapy.
So, to all those readers thinking of taking a drug holiday, I have to say that any improvements in the quality of my life were marginal, although gastro-intestinal problems did lessen but this could have been the effect of the US diet.
I took my holiday from the pills to take a ‘real’ holiday and we had a great time. But like any holiday, the return to the horror that is everyday existence has been a little more intense than usual this time.
