Against the Odds
One Man's Battle Against HIV, Depression, & OI's
Mark Hudson did not look like a man who had spent the better part of the last year battling an opportunistic infection most people have never heard of. His slow smile and handsomely tanned face blended with his slight Southern accent to produce the impression of a man in easy control of his destiny. The last year, however, has been anything but easy for Mark.
Mark's story began in 1991 when he was diagnosed with HIV. He was working as a landscape designer at the time and he continued to work full-time about a year longer. In 1993, however, he became so depressed over his HIV status that he became disabled. In 1995, Mark was treated for MAC (mycobacterium avium complex, an opportunistic infection frequently contracted by HIV-positive persons with low T-cell counts) and then was well until May of 1998, when an x-ray showed a suspicious shadow on the upper part of his right lung.
The spot turned out to be caused by Aspergillus, a fungus that is virtually everywhere in the environment, especially in soil and plant debris. Because Mark was a landscape designer, he may have had more contact with this organism than the average person. Most people breathe it in every day without harm to themselves, but persons with damaged immune systems -- cancer patients and people with with low T-cell counts -- can become seriously ill.
Aspergillosis infection of a body organ is a relatively rare but frequently fatal opportunistic infection. A damaged immune system, prior treatment for MAC, and a low T-cell count are all risk factors for this disease. Most commonly it invades the lungs, and can grow into fungal balls (much like those on cheese left too long in the fridge) that are difficult to diagnose and even more difficult to treat. Despite the advantage of having top-flight health care at the University of Washington, Mark's disease was not diagnosed until July, after consultation with several infectious disease specialists. Meanwhile, he was having more pain and increasing shortness of breath. The fungus ball inside his lung was growing larger.
As soon as his providers were reasonably sure of the diagnosis, they started Mark on a drug called amphotericin B. Ampho, as it's called for short, is not only toxic but must be given daily through an intravenous line. Mark had such shaking chills from this drug that he had to get other drugs beforehand to decrease the severity of side effects. Ampho is the current standard treatment for invasive fungal infections, but recently scientists have been investigating another class of antifungals, called echinocandins. Although they must also be given intravenously, they seem to have fewer dangerous and uncomfortable side effects. (For more information on clinical trials of an enchinocandin antifungal, call the HIV Research Program at Swedish Medical Center: 206-386-2523.)
Despite drug treatment, Mark's condition did not improve. In August of 1998 he had surgery to remove the diseased part of his lung. Mark tries to downplay this difficult period in his life, but his smile disappears and his voice grows softer as he talks about it.
"I was having a lot of pain, and my depression was getting worse and worse. I eventually started thinking of killing myself." Mark credits the fierce support of friends and family and the people in his support group at Seattle AIDS Support Group in getting him through. "I probably wouldn't be alive if it weren't for them. They were amazing."
Eventually the pain subsided, and proper medication has helped him handle his depression. Although he credits his family and friends the most, he says this experience has given him a whole new outlook on his health.
"Before, I didn't really care to know anything about HIV. I let my doctor do the work, and I just did what he told me." Now Mark takes part in the decisions that affect his health, retaining the ultimate yea-or-nay over his treatment regimen. "I think it's important to take responsibility for yourself," he says. "My friends and my family definitely played the most important role in my recovery, but a close third was me taking active part in my care."
Knowledge is power, and sometimes it is life itself.
This article was provided by Seattle Treatment Education Project. It is a part of the publication STEP Perspective.