Tuesday, September 8, 2009

How do you explain...

My patient today is HIV+, has Hepatitis C and is on hemodialysis for his nonfunctioning kidneys.

He would like to be evaluated for a kidney transplant, which you can totally do in HIV+ patients. However, it's his Hep C that may stand in his way. It's really hard to treat Hep C after someone gets a transplant, so we try to do it beforehand. But, it's really hard to treat Hep C in patients on hemodialysis because the toxicities of the medications are so much worse.

You can do it, but the success rate isn't great. There's a new drug that should be out in about a year, but that pushes his (potential) transplant off for a year. And there's an old drug that is being looked at for a new use - Hep C treatment. It's not being tried in HIV patients yet, and he feels slighted. The patient said, "Why do they always leave us out?"

He's right. People with HIV have been marginalized in society and in medicine. However, when researchers are trying out new medications, they want to try them on the people who have the best chance of responding. The ideal patient. Patients with HIV are not ideal patients and so they are excluded from most trials.

How do you explain that to someone who feels neglected and uncared for? Who has lived through the days of Martin Luther King, Jr. Who has watched people die of HIV. Who now lives alone in a nursing home. Who probably feels the whole world is against him. I can't blame him.

I was able to convince the attending to look at the patient's case and see if we can't at least try something. We'll see what happens. Hopefully we can at least try, and if it doesn't work, well, at least we tried. And he is validated that we cared enough to try.


Ask Angie said...

All you can do is try. It's sad how HIV has just fallen off the radar. I am incredibly concerned about that - especially for the younger generation who is back to thinking their biggest fear is pregnancy or an STD that can be cured with antibiotics or a horseback ride on the beach (thank you herpes commercials). I am so grateful that there are doctors out there like you that honor humanity - no matter what the cells in their body are doing.

Julia said...

i can't even imagine sitting across from someone, trying to explain all that... his life hanging in the balance. you are truly a caring doctor.