OCD, depression, and HIV
Feb 12, 2013
I've been on HAART for 8 years. My viral load has been undetectable for most of that time. Other than a low of 150, my CD4 count is normally about 250-300 (with a high of 345). I have to admit that there have been many times when my adherence has been poor as I struggle with depression and severe OCD. Actually, I am very adherent to the sertraline and clonazepam for my OCD; it's just the HIV meds that I skip. It's not that I'm afraid of the pills. I just constantly have thoughts that if I don't take the HAART, the HIV in my body may kill the OCD. I know the OCD is not a virus, but it really feels like there is something controlling my brain, and I really want it to stop. I've never been able to shake this feeling, so I don't think I will ever improve my adherence. Having to take many pills twice a day (ritonavir, darunavir, raltegravir, etravrine), makes the struggle even harder.
I have an excellent family physician, ID specialist and psychiatrist, so I am very well cared for. My physical health is good. It's just the mental health issues that I can't overcome. I receive a disability pension because the mental health issues are severe, so I really can't complain. Also, all HIV meds are dispensed without charge in my province, so I really have to keep reminding myself how fortunate I am.
Despite my good fortune, the OCD has overtaken my life, and I suspect my adherence will continue to be poor. Therefore, I was wondering if we can expect that any of the combo pills like Atripla or Complera will ever be available to patients who are not new to treatment? I think it would be much easier for me to adhere to my medications if I could take just one pill once per day.
In the meantime, I'll continue to try to ignore the thoughts in my head and try my best to follow the doctors' instructions. I just think it would be easier to do so if I could reduce the number of pills I have to take each day.
Thank you for all of the advice you provide. This website has been very helpful to me over the years.
Response from Dr. Fawcett
Thank you for writing and doing so well maneuvering all of these complex medical and psychological concerns. I am glad you are seeing a psychiatrist and other providers who can assist you in this process. If it is not already part of your psychotherapy, you might inquiry about some cognitive behavioral therapy that can specifically address the irrational belief that HIV will somehow rid you of OCD. You may also want to consult with a psychopharmacologist who could collaborate with your healthcare providers to see if there may be some drug interactions, or even a way to reduce your pill burden.
As for the future it is, of course, impossible to predict how medications may be dispensed. Based on the past I am quite certain that taking antiretrovirals will become easier and easier for everyone affected by HIV.
Best wishes to you,
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