Before you decide to start on the newest of the protease inhibitors, there are a few things to take into consideration. Those little snacks just before bedtime? Well, forget them. There will be no more. How about those late afternoon coffee or yogurt breaks? No more of them, either. You'll be starving so that your stomach can take full advantage of the drug; otherwise, it appears that the virus can easily mutate and become resistant, rendering it ineffective in the treatment of AIDS.
The directions on the bottle will say the following: "Take two pills three times a day. Take doses eight hours apart. Take medication on an empty stomach, one hour before or two-to-three hours after meals unless otherwise directed by your doctor. Medication should be taken with plenty of water."
Okay, let me get this straight. I'm in the middle of wasting syndrome (more than 10% of the body weight lost over a short period of time), trying to gain it back, and now you're telling me I can't eat anything for 9-to-12 hours a day (one hour before and three hours after -- that's four hours, three times a day). I sleep for 10 hours a day. Check my math, but doesn't that leave me with only two hours a day in which I'm allowed to eat?
Let's try to set a reasonable schedule. The day begins at 8:00 a.m. and the first dose of Crixivan. You're allowed to take it with coffee, tea, juice, skim milk or a light meal (toast or dry cereal). An hour later, you might be eating breakfast, but because you tried to drink a lot of coffee, you're not very hungry. Lunch is at 1:00 p.m. and you try to eat as much as you can and start your starve for your next dose of Crixivan at 3:00 p.m. You are not allowed to eat anything until 6:00 p.m. and then you start your next starve at 7:00 p.m. for the 10:00 p.m. dose, just before bed.
But this is still not what is recommended. TAKE DOSES EIGHT HOURS APART.
Let's try again. You set your alarm clock for 6:00 a.m., splash water in your face to make sure you don't choke on the pills (two large capsules), and you take your first dose of Crixivan. You go back to sleep. Now, you can eat anything for breakfast as long as you do so after 7:00 a.m. Lunch must be finished by 1:00 p.m. to start a starve for the 2:00 p.m. dose. Dinner is any time after 3:00 p.m. but you must be finished by 7:00 p.m. to starve for the 10:00 p.m. dose.
What's wrong with that, you say? Well, for one thing, how would you like to know that for the rest of your life, every morning, every morning, you have to get up at 6:00 a.m. There are no Sunday sleep-ins. There is no "Tell my boss I'm sick." Day after day after day after day, get up at 6:00 a.m. We're not talking about taking an antibiotic for two weeks; we're talking for the rest of your life. Think about it. And if you start adjusting the schedule, you end up having to force yourself to stay up so late, so that more than likely you'll fall asleep on the sofa watching TV and miss your dose completely.
But just for the sake of argument, let's say that you decide to move the schedule around so that you can sleep in until 8:00 p.m. You'll end up eating lunch at 3:00 p.m. and dinner at 7:00 p.m. to 9:00 p.m., and starving until midnight. Eight hours of sleep usually isn't enough, as fatigue is part of the AIDS syndrome and sleep is a requirement, not a luxury. You can nap, you say. Yes, you can -- if you can.
Now let's go back to wasting syndrome. You are advised to eat six small meals a day. Any suggestions? Yes, it can be done, but then living with AIDS becomes a full-time job and you never get to forget for two minutes in any day, that you have it. If you just have to take a few pills, you can pretend that you're just taking your vitamins and go on about your life, but when you have to strategically plan everything you put in your mouth, every hour of every day, it goes beyond intrusive to impossible.
And God forbid that you are on ddI, which requires yet another, separate three-hour fast for its daily dose, or are on fiber therapy, which is like taking a meal but without the nutrition. It fills you up, but it is only fiber. When do you take that?
Crixivan does have the potential of being a "silver bullet," but you have to be totally committed to taking it correctly. Once you start taking it, there's no turning back. The virus is unforgiving and can develop a resistance to the drug easily if not taken properly and consistently. So, before you start down the Crixivan road, stop and think about it. The directions may sound simple, but living with them is another thing entirely.