Tuesday, July 12, 2011, H4 Ward San Lazaro Hospital, Manila. It was the final day of the ARV treatment counseling. My dad, Jay, and I were all waiting patiently at the ward's entrance. My name was called at around 2 PM, I was the first patient to be counseled. At the table near the back of the doctor's clinic area, awaits 4 doctors. 2 dermatologists; one dermatologist looks like an Indian while the other one is an old Chinese mestizo, the doctor who counseled me who is infectious disease specialist was there, and one of the most tenured doctor in H4 ward who is also an infectious disease specialist took the lead; all were waiting for me. Papers were preparedly piled, booklets as well as handouts. I introduced myself, Jay, and my dad to the lead doctor and we all sat at the other end of the table, me sitting next to the lead doctor. The doctor then told me that this is the final stage of the counseling and we will review what I have learned during the first two sessions, making sure that I already fully understand the processes of HIV treatment. Below are the questions and what I answered as well as few of the discussions.
Lead doctor: What are ARVs for?
Me: They are medicines that inhibit the replication of HIV viruses inside the CD4 cells. There are what we call protease inhibitors and others that blocks the virus from getting the cell's DNA, stopping the virus from replicating itself.
Lead doctor: What are CD4 cells and what they do?
Me: CD4 cells are helper cells, a kind of antibody that tells other antibodies that there are invading bodies inside the system.
Lead doctor: What are the relevance between CD4 cells and HIV?
Me: The HIV virus needs the CD4 cells for it to multiply, as they go inside the cell and replicate, the CD4 cell dies. It goes on and on, repeating the process.
Lead doctor: Name three types of ARVs and one significant side effect of each.
Me: Nevirapine - rashes that may lead to Steven Johnson disease; Efavirenz - dizziness, Lamivudine/Zidovudine - anemia.
Lead doctor: How long are you required to undergo treatment?
Me: For a lifetime.
Lead doctor: What are the purposes of taking ARVs?
Me: To prolong a patient's life, to raise up my CD4 level, to lower a patient's viral load down to undetectable.
Dermatologist 2: What are difference between adherence and conformance?
Me: Conformance is doing what is needed as directed or conforming to what is needed to be done. Adherence is doing what is needed on time.
Dermatologist 2: What are the intervals in-between and taking each type of pill?
Me: 12 hour intervals between each dosage and 1 hour apart for each type.
Dermatologist 2: Name the ARVs and when you are supposed to take it.
Me: Nevirapine once a day at 8pm, Lamivudine/Zidovudine twice a day every 12 hours, so that will be 9pm and 9am.
Dermatologist 2: If you are 30 minutes late in taking your medicines are you going to double the dosage?
Dermatologist 2: Nevirapine will be increased to what dosage and when?
Me: Twice a day 12 hours apart, 8pm and 8am after two weeks of no violent side effects.
Dermatologist 2: Are you depressed?
Me: During the first few weeks of diagnosis of course I was, but I am okay now.
Dermatologist 1: What will be the trigger for you to be confined here?
Me: If there will be rashes or diarrhea or any severe side effect.
Dermatologist 1: Is it okay for you to be confined here?
Dermatologist 2: Are you sexually active?
Me: Not at all.
Dermatologist 2: Were you sexually active?
Me: Not even.
Dermatologist 1: Does your partner know?
Me: When I had one, yes.
Lead doctor: Do you practice safe sex?
Me: I haven't had sex for along time, I'm not active at all, if ever I do, of course I will.
Dermatologist 1: What diet are you practicing, if any?
Me: Yes I am, the hypoallergenic diet, and I was hoping rice would be on the list.
Dermatologist 2: You are overweight. Once you have settled to a particular combination of medicines your next goal is to lose unwanted weight. You are two times prone to heart diseases compared to uninfected obese individuals. Right now, you watch what you eat, be extra careful. No smoking nor drinking.
Me: Is it okay to take glutathione?
Dermatologist 1: For what?
Me: To clean my liver before I take my first pill. I do believe that the medicines are already toxic and may stress the liver.
Dermatologist 1: Its effects aren't clinically proven, so we don't recommend you do it.
Dermatologist 2: If you want to take care of your liver, stop smoking and stop drinking.
Lead doctor: Also, no multivitamins for now and nothing of any type of food and herbal supplements.
Lead doctor: If your CD4 goes up as high as 1000, are you supposed to stop ARVs and why?
Me: No, because the ARV's purpose is to set a block for the HIV and the CD4 cells. If I stop taking ARVs that block or wall will be stopped, enabling the virus to get a hold of a CD4 cell and start replicating again.
Lead doctor: What will happen if you stop taking ARVs at any given time?
Me: The virus might or will develop resistance to the medicines and I may have or will need to take the 2nd line of ARVs.
Those were some of the questions and discussions during the last part of the counseling. I felt like I was in a panel interview or I was a student presenting a report to a panel of professors with my friend and dad as audiences. I was kind of nervous answering their questions, afraid that I may answer a wrong one. I even felt that I was graded! Dermatologist 2, was very strong in his statements and has a strong command of words. Dermatologist 1, was the quiet type, the counselor doctor was quiet the whole time, the lead doctor, she was already my doctor in my previous visits, she has a very strong character.
After the almost hour long discussion and reviews, the lead doctor prepared the papers for enrollment, my enrollment for ARVs, she said delightfully "alright, you are indeed ready to be enrolled". Then dermatologist 2 said "I think you more than ready, you are happy". I replied, "I am very much ready and being happy is my choice. I am even excited to start the treatment!". There were a couple of papers to sign and Jay and my dad has to sign as well, as witnesses. I was given a booklet that looks like a bank passbook, it will record the ARVs I get from the pharmacy. After we signed the papers the lead doctor told us to proceed to the pharmacy and get the medicines. I shook her hand as well as the other doctors and thank them for a wonderful discussion. The three of us then headed out of the ward to get my medicines then off to a late lunch at SM San Lazaro.