SEX & PHARMACY

Whenever I need a break from the demanding world of pharmacy academia, I indulge in a little television. Every time a television program goes to a break, I can never escape three types of commercials: cars, food, and of course, prescription drugs. Those oh-so-wonderfully-realistic prescription drug commercials are the most noticeable and the most generic. They all start off the same—someone has a problem or a sickness yearning to be fixed which is quickly solved or magically healed by the advertized medication. However, there’s always a catch. All prescription drug advertisements are followed by a quick yet seemingly endless parade of possible side effects. A side effect is defined as an undesirable effect of a drug or a treatment. By the end of the commercial, I contemplate whether taking the drug is worth the risk of suffering from all those side effects. Whatever I conclude at the end of the commercial, I quickly forget it because in the end, if I need to take a drug, I will take it. When we are faced with a situation that could result with a million cons, and one possibly great pro—it is almost instinctive to go for the pro, regardless of the side effects. This is because we all desperately hope that the pro will surpass all of the cons.  With sex, this concept is no different. For those of us who engage in sexual activity, we are opening ourselves up to many potential side effects. A sexual relationship could lead to a broken heart, which could be dramatic. Sex could also lead to a slew of STDs, which could be traumatic. Sex can obviously lead to an unwanted pregnancy, which would be problematic. Yet, we still have sex because of that mind-blowing, earth-shattering orgasm with many more orgasms on the horizon. We have sex to achieve levels of intimacy that may only be expressed with physical love. We have sex because it’s passionate, spontaneous, and fun! As a wise man once said, “Sex is emotion in motion.” The benefits of sex overshadow the risks exponentially—just like how the benefits of a drug overshadow the side effects. Anyone taking a drug is informed of the potential side effects. In fact, finding a drug without a side effect is just as easy as finding an effective female sexual dysfunction drug—it’s practically impossible. So the risks are known, and the benefits are known. Millions of people across the globe entrust that their prescription drugs will make them better despite all the potential or inevitable side effects. When there’s so much risk in the choices we make, why do make choices that neglect the obvious obstacles of side effects?

I decided to meet up with an expert on side effects. I met Greg. Greg is 48, in a relationship, and like most Americans, has prescription medication.  He seems just like any other American, but that’s not the case. He has suffered side effect after side effect, each seeming more serious than the last. This is all because Greg, like millions is experiencing perhaps the ultimate side effect of sex; Greg has AIDS. I had only spoken to Greg via email prior to our meeting in which he agreed to an interview. We decided to meet at a quaint, coffee shop just off Government Center. As I sat, waiting for him I wondered what he would look like. After all, he wasn’t HIV positive; he told me he had AIDS. Based on my perception of AIDS through my studies and through the media, I expected Greg to be gaunt, unable to walk on his own, and on the verge of death. That wasn’t the case. In walked a tall, slightly overweight guy who looked just like anyone else. After shaking hands and chitchatting, he told me his story.

In 2001, Greg noticed that he had a torn retina. After visiting puzzled eye doctors, he eventually got several blood tests done to see if he had any bacterial infections. No one seemed to understand why Greg’s retina was torn. Everything came back negative. Then he was informed that one more test was necessary, an HIV test. Someone from the doctor’s office called him on the phone and told him that he was HIV positive. Just so you know, informing someone of his or her HIV status over the phone is not only illegal, but also extremely dangerous. Naturally the news was devastating to him. He thought his life was over, and many times, even around the time of our meeting, he contemplated suicide.

When Greg went to the doctor for his first HIV check-up, it was discovered that he had only 46 CD4 cells. A healthy, HIV-negative, person has anywhere between 500 and 1,500 CD4 cells/mm³.  His doctor was wondering how he was still alive. People are generally diagnosed with HIV first. An AIDS diagnosis is typically confirmed after an HIV diagnosis and when a patient’s CD4 count is 200 or less. It was discovered that Greg had been living with HIV for at least a decade, perhaps even two decades. He never thought for a second that he was HIV positive. At his doctor’s office, he took his first HIV drug treatment, azidothymidine, commonly known as AZT. AZT was the first FDA approved drug treatment for HIV. It is typically the drug an HIV positive person gets started on during his or her HIV drug therapy. AZT is an antiretroviral drug that inhibits reverse transcriptase, the enzyme that the virus uses to copy its RNA into DNA so it can replicate. AZT has side effects of nausea, vomiting, body-fat changes, headache, muscle aches and even more serious side effects of anemia, discoloration of eyes, and lactic acidosis. Greg said that he experienced vivid nightmares every night while taking AZT. Nightmares aren’t uncommon with HIV antiretroviral treatment. He eventually stopped taking AZT because it nearly cost him his life. He developed lactic acidosis, which is a build-up of lactic acid in the body. He is now taking Atripla. Atripla is a combination of 3 HIV medications (600 mg Efavirenz, 200 mg Emtricitabine, and 300 mg Tenofovir) that is one pill to be taken once daily on an empty stomach. He said the side effects are mild, although it makes him feel tired from time to time.

AZT was just the first of many prescription drugs that Greg would have to incorporate into his lifestyle. Because of his AIDS diagnosis, he has developed numerous conditions which include asthma, hypertension, severe cough, diabetes, insomnia, night sweats, thrush, rotted teeth, spinal meningitis—the list goes on. So because of these conditions, he is on a strict, thorough drug regimen to treat these illnesses. Greg takes over 30 pills per day. In addition to Atripla, Greg is on Thiamine, Ribloflavin, Folate, Vitamin B-12, Nizoral cream, Lantus, Actos, Allegra, Singulair, Rhinocort Aqua, Advair, Lisinopril, Calcium carbonate, Nexium, Hydrochlorothiazide, Aldara, Sonata, Wellbutrin, Depakote, Gabapentin, and Lamotrigine. For those us who work in a pharmacy, every now and then we get a patient calling in to ask the pharmacist about certain side effects of a particular drug. Imagine a patient asking about side effects of the twenty prescription drugs they’re taking. Each one of these drugs has side effects and when these drugs are taken together, they have even more side effects. Greg has suffered side effects from all of these drugs, most noticeably—he gained weight. He once tipped the scale at 300lbs. Also because of his drug regimen and his AIDS diagnosis, Greg has developed severe depression, which has made him required to visit a therapist weekly.

The side effects of AIDS and his drug regimen go well beyond clinical symptoms. Because of AIDS, he has been declared disabled, which has left him unemployed. He couldn’t physically work because his body would exhaust easily. Another side effect of his AIDS diagnosis is the ending of his relationship. His partner isn’t HIV positive. Greg contracted the virus while he and his partner were together. This has put a severe strain on his relationship; the two are parting ways after two decades of being together. Greg has lost his job, his love, friends, control over his body, and worst of all, his will to live. This is all a side effect. This is all because of one moment in which he made a choice, a choice that consequently left him HIV positive unknowingly for years, a choice that leaves him, relatively alone with AIDS. Greg falls into the category of the 32% of people in the United States who contract HIV through non-regular partners. Greg lives with his mistake every day and is reminded of it with each pill he takes, each job he gets turned down from, and each person who quivers when he reveals he has AIDS. Greg told me that people are afraid to shake his hand because they’re afraid of getting HIV or AIDS. The social stigma associated with people who have HIV and AIDS is an unfortunate obstacle Greg and others have to face. It is also a serious side effect of the ignorance that exists with regard to HIV and AIDS. It must be reiterated that HIV cannot transmitted through casual contact. It is only transmitted through bodily fluid transfer, and this doesn’t include saliva. It includes blood, vaginal, and seminal fluid.

As he left the coffee shop, I saw a man with no hope or will to live. The irony of it all is that Greg is relatively healthy. His CD4 level is roughly 500 cells/mm³. His viral load is low and his body has become so used to his prescription drug regimen that the side effects are less severe. He has made a fantastic turn-around from the time of his diagnosis in 2001. Before parting ways, he and I agreed to meet again to check up on how he was doing, not for my article, but as a friend.

I didn’t see him for a month because he was admitted to the hospital for his mental health. His depression and suicidal thoughts were so rampant that he wouldn’t take his medication.  When I eventually did see him, I saw a different Greg. He was happier and surprisingly optimistic. He told me of his stay at the institution and how angry and depressed he was. He said the therapy there did him some good. Although he continues to struggle with his illness, he hopes to move forward. He told me of his plans to move to Boston and start over. Although regret follows him, his hopes remain high. My hope in him is very strong, and our friendship has been good for us both.

December marks the ending of an era, the last month of a year that has gone by so quickly. December also marks the beginning of AIDS Awareness Month. The Center for Disease Control and Prevention (CDC) concluded that nearly 56, 300 people in the United States were infected with HIV in 2006 (2006 is the most recent year available). The CDC also estimates that 36,828 cases of AIDS were reported in 2006. After reading this article, I would expect no one to take this month lightly. Take time to educate yourself about HIV and AIDS. What people seem to forget is that HIV and AIDS are illnesses. HIV/AIDS patients deserve the same level of compassion that we would give to those with Alzheimer’s, Breast Cancer, Multiple Sclerosis, and other debilitating diseases. Greg has met some amazing doctors. His doctors are his friends. As future health care professionals, we need to have hope in our patients especially when they have no hope from others or hope in themselves. Will Cribby, the former director of Residence Life left me a powerful quote, framed as gift to remind me of my experiences on the Wellness Floor. The quote states, “In times of change, there is no incentive so great, and no medicine so powerful as a hope for a better tomorrow.” This quote remains true for patients such as Greg and for health care professionals of tomorrow, such as ourselves. So this brings us back to my initial question: When there’s so much risk in the choices we make, why do make choices that neglect the obvious obstacles of side effects?  We may not be able to overcome the inevitable side effects of medical treatment, but we can overcome the side effects of ignorance, social stigma, broken hearts, and even the deadliest disease on the planet. We can bear all side effects with hope and compassion. As one can see, side effects may include many things but hope includes much more.

© 2008