Living With HIV
Trekking With AIDS, Part 2 -- A Special Report
After Four Months and 1,346 Miles, an 11-Year Veteran of Various HIV Therapies Has Completed Half of the Appalachian Trail -- Without Missing a Dose of Her Five-Drug Antiretroviral Regimen
I need new feet. New boots won't do it: I've been through three pairs in the past five weeks, and I still can't find anything that will hold up to the pace I've set myself -- which is somewhere between 20 and 25 miles a day, depending on the terrain, the weather, and my mood. At the time I filed my first report, my companions and I were in New Hampshire, where we felt fortunate if we could cover half that distance in a single day as we made our way over the White Mountains.
That stretch of the Appalachian Trail is all uphill and down, and from the highest peaks New Hampshire looks like a deep-green sea, with one great swell after another stretching to the far horizon. You don't hike New Hampshire; you mountaineer across it, and it was somewhere in the appropriately named Granite State that I first heard a fellow trekker say, "Tomorrow is going to be a very technical day." What "very technical" means, I have learned, is "very steep," "very demanding," "very challenging." The very technical sections of the Trail are hard on the hands and knees, but they're not as hard on the feet as long miles are.
The mountains of New Hampshire are several states -- and several months -- behind me now. The low hills and deep swales of Pennsylvania, which we are passing through as the leaves fade and fall, are a different story altogether: Here we can, at long last, cover a considerable distance every day. This is beautiful country, but it is boot-eating country. I don't know if there's a boot -- or a foot -- made that can stand up to long miles and rocky terrain, week in and week out, but if there is, I sure don't have either one. Oh, there are boots that show very little wear and tear -- but that's because they tear up the wearer's feet. As for the rest, they feel great for a week or so, before they begin to come apart at the seams.
As a result, my feet are coming apart at the seams, and the ritual of caring for my feet -- soaking them, powdering them, paring away built-up calluses, applying antiseptic cream and fresh bandages to split pads -- has become as much a part of my daily routine as taking my antiretroviral meds. The difference is that this ritual is one that I can share with other through-hikers, whenever I encounter them on the trail or at a campsite. Indeed, we swap blister remedies the way non-hikers swap icebox-cookie recipes, gardening tips, fish stories, and golf scores.
A new treatment for lipodystrophy?
Like many treatment veterans, I have been taking protease inhibitors since they first became available. My current regimen includes two, Fortovase® and the new gel-cap formulation of Norvir®. As many of you know from personal experience, these potent drugs are capable of suppressing viral replication to levels so low that HIV can no longer be detected in your bloodstream, even by ultrasensitive assays. My current regimen has done that for me. As many of you also know, the protease inhibitors can cause serum cholesterol levels to skyrocket, and they can cause other changes in body composition as well, chief among them the appearance of fatty deposits on the thighs, stomach, and shoulders. My current regimen had done both of those things.
Then I hit the trail. I didn't change my regimen in the slightest, but I did add ten hours of steady -- and often strenuous -- exercise to my daily routine. And by the time I got my blood work done, two months into this great adventure of mine, my "protease paunch" had all but disappeared . . . and my serum cholesterol, which once exceeded 600, had dropped to 225. In a recent article, "Update: Treatment of HIV-Associated Body-Composition Abnormalities," Dr. Marc Hellerstein discusses the newest approaches to the clinical care of HIV-positive individuals who have developed wasting syndrome or the unsightly fatty deposits that healthcare providers call lipodystrophy. Nowhere in his fine review article does Dr. Hellerstein mention hiking the Appalachian Trail as a treatment for lipodystrophy . . . but I am persuaded that it has helped.
More important, my own experience suggests that regular exercise plays a crucial role in curbing, or even reversing, the lipodystrophy and other metabolic derangements that can result from long-term multidrug antiretroviral therapy. Walking eight or nine hours a day has resulted in a dramatic drop in my serum cholesterol count and has melted away my protease paunch. Now, I certainly can't keep walking eight hours a day forever. I've already covered almost half of the Appalachian Trail, and I hope to walk home to Atlanta sometime in late January. But it seems to me that there is an important lesson in this for all of us who are dependent on protease-inhibitor-containing regimens to keep HIV in check, and the lesson is that exercise helps. Eight hours of steady exercise helps a lot, but it's my guess that something less than eight hours would also be a big help . . . and even an hour of brisk walking, every single day, might well make a difference.
I say it's worth trying. If nothing else, the time you spend walking is time for reflecting on the past, and planning for the future, and counting your blessings. I know, because I do that every day, as I make my way south, toward home.
For Part 1 of this report, click here.
For Part 3 of this report, click here.
Dawn Averitt is the founder of Women's Information Service and Exchange.
Back to the October 1999 AIDS Care contents page.
This article was provided by San Francisco General Hospital. It is a part of the publication AIDS Care.