Breaking Up is Hard to Do

I’ve been on the same HIV medications for nearly a decade. My treatment works, so I haven’t been eager to change things up with a new regimen. Why risk messing with a good thing? 

Okay, it’s not that I’m in love with my current therapy, but we’ve been together through thick and thin. Sure, I have some annoying side effects I end up having to treat as well, but I remember how bad things were 10-15 years ago and I can’t imagine giving up the life I’ve been able to build around the success of this therapy. It’s like a relationship, when you’ve been through emotional rollercoaster with enough Mr. Wrongs, you’re thrilled to meet Mr. Good Enough. Before I got on this treatment I couldn’t work and I could barely get myself out of bed on the bad days. 

With Mr. Good Enough, I figured there was no reason to switch meds. After all, a lot of experts only talk about when to switch meds only in the context of when your HIV therapy stops working, which mine hadn’t. My doctor says antiretrovirals can stop working for a variety of reasons like poor absorption, drug interactions, adherence issues, and the ever-present development of drug resistance. So why would my doctor want me to switch?

No, I haven’t taken my meds 3,850 days in a row without fail, but I’ve come damn close, and as far as I know, I’m not having absorption issues. Are my drugs interacting with other meds I’m on? Possibly. My doctor has suggested that I could be building up a resistance. But I’ve been on these same meds and pretty much this same dose for years and I’m not noticing any new issues. So I’ve been hesitant to even consider turning in a winning hand for the slim chance I’ll get an even better one next time around. 

My logic has always been that all antiretrovirals have side effects. I’ve been taking calcium to combat bone loss, over the counter meds for constipation and diarrhea (thankfully not on the same day), and prescriptions for sleep, depression, and pain. I’m already used to taking the stuff I take to deal with the side effects I have (and the stuff I take to deal with the side effects of the stuff I take for side effects) and don’t want to go through starting over again. At least I didn’t use to.

I’ve had an epiphany: maybe things can get even better. I’ve adjusted to living with side effects that I just might no longer need to put up with. Sure, these days I’m managing my chronic condition, but somedays it feels like that’s all I’m doing. Managing. As so much has changed with HIV treatment in the past 10 years, there are a handful of new medications on the market that are better and easier to stomach (literally), and I can also switch to a pill I take only once a day. (I also got new insurance under the Affordable Care Act, so the newer treatments I was afraid weren’t covered, actually are.)

I’ve changed too. I’m sneaking up on the half a century mark and my doctor says both HIV and the treatments I’ve been on have “aged” certain parts of my body faster than others. My concerns have changed over time too. When I was younger I was terrified of developing one of those “buffalo humps” I saw some of the older guys with. So I refused to take meds that listed fat redistribution as a potential side effect. I’m less afraid of looking like Quasimodo now (as long as my husband still finds me sexy) and more concerned that my kidneys might fail. 

I’ve never had a fear of commitment, just change. I’m realizing just because I can stick with one HIV treatment regimen for decades doesn’t mean I should. I’m not heading to divorce court, but I might just play the field anyway — at least when it comes to HIV meds. After some research and long conversations with my doctor, I started taking a new single pill regimen that uses a different form of tenofovir, which has shown to reduce kidney toxicity and have fewer decreases in bone density compared to other antiretrovirals.

I have high hopes but what if this experiment in playing the treatment field fails? Well, I can always run back to my old flame. Which isn’t that bad of a fate. 

Except maybe for the diarrhea.