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What are meds that will work for those who are broke
Aug 19, 2007

I have a friend with very advanced HIV. She has been pos for 13 years and only took meds for a few years. Her current cd4 count is 3 and her vl is in the millions. She has had a cd4 count below 19 for the last 3 years and doesnt focus on her hiv meds. He is addicted to pain meds and even goes to the hospital acting like she is in pain to get IV pain meds. She has had a lot of opportunistic infections but they always save her. Her latest was a 2.5 week stay in the hospital with anemia, very low white blood cell count and platelet of only 6k. She almost died, nothing was working for about 10 days and I cant even tell you how many platelet transfusions she had. They finally took a risk and gave her IV steriods and they seem to be working. I dont think anyone is more surprised than the doctors that she is still alive. She has no insurance so they let her out of the hospital as soon as they could get her off IV meds. She has diarhea all the time and weighs about 88 pounds right now and is only taking HIV, Potassium, Prednisone and other meds sporadically but sure takes her pain meds. She goes to different hospitals each time and since she looks so bad they always admit her for several days to see what all may be wrong. She never tells them she already had tests at other hospitals. Any ideas on meds that she could take that would be only a few pills and less expensive so maybe she will go ahead and get them. And how do you get the hospitals in the area to quit always givng out pain meds when she goes to the emergency room. Why dont hospitals have a better way of pulling up info on people to know where all they have been treated.

Response from Dr. Young

Thank you for your post.

It indeed seems like your friend is desperately ill with symptomatic AIDS. I'm suspecting that she likely has multi-drug resistant virus, though you've not commented on this.

A central issue for her is establishing a relationship with an experienced HIV treater- one that is willing to work with her narcotic needs. This can often complicate establishing relationships and her going from hospital system to system further fractures her care. Such "doctor shopping" is seen, from the medical establishment, as a means of getting additional narcotics behind the backs of the doctors providing care- something that is very much frowned upon. Lastly, it is a waste of medical resources and your friends health that she not tell each new hospital about her previous hospital care and laboratory assessment- just wastes valuable time- time that might prove to be critical to her prognosis. Hospital systems cannot access each other's information because of laws that protect patient confidentiality. It's up to your friend to provide permission, not the other way around.

What city or state do you live in? Assuming that you are writing from the US, the lack of insurance shouldn't be a significant long-term issue, since with the symptoms you describe, she clearly has AIDS and would be eligible for government programs. With today's options, the vast majority of patients, even those with highly drug resistant virus can acheive undetectable viral loads. Indeed, in my group of patients, nearly all of our highly drug-resistant patients now have undetectable levels. Selecting HIV medications requires much more information that you've provided and is a very individualized decision process. Such medications (or any combination HIV therapy) are terribly expensive to purchase- ranging in the tens of thousands of dollars per year. I'd advise finding your local AIDS service organization (ASO). Check out TheBody.com's ASO finder for assistance.

Best of luck to you and your friend. BY



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