The Bay Area Reporter - June 6, 1995
Mark Bowers, ACT UP/Golden Gate Writers' Pool

In reality, early intervention saves lives.

For many, AIDS is a disease of wasting. Lean body mass is spent while fat mass is retained. The Kotler studies have reaffirmed in AIDS what was learned about the metabolic changes in Irish hunger strikers and World War Two prisoners of war: once a person loses about half of their lean body mass, death ensues. In many cases, despite what the death certificate says, the real cause of death is AIDS wasting.

The metabolic changes that accompany HIV disease start early and are continuous. They can be detected well before there is any weight loss. Many, such as lactose intolerance and vitamin deficiencies, can also be addressed immediately through several important complementary strategies. Physicians now know to provide HIV patients with nutritional consults. The dietary needs of an HIV positive person are different from those of an uninfected person, and dietary changes can be made immediately without any toxic side effects. The effects of changes in dietary habits early in the course of HIV disease are increased absorption of nutrients, better general health, and probably a longer asymptomatic period.

The story about metabolism doesn't end there. Physicians are increasingly aware that nutrition is only a first step in building up lean body mass in people with HIV. In addition to nutritional intervention as a way to prevent unwanted weight loss, some people in the community are experimenting with anabolic steroids, although there is little research on this approach in HIV-disease. Other hormonal therapies are also being used to treat wasting syndrome: these include synthetic progesterone and human growth hormone. Each of these strategies can be used in the context of HIV disease, and the positive results are startling.

Changes in the way people approach general health maintenance can be an important form of early intervention as well: elimination of harmful behaviors that speed disease progression are part of the general health maintenance strategy, as is the incorporation of progressive resistance exercise to build up stores of lean body mass. If an increased amount of lean body mass is associated with a survival benefit of several years and increased quality of life, it makes sense to start in early.

One of the most important and most individualized early intervention strategies is stress reduction. No one stress reduction technique works for everyone, nor should we expect it to. Indeed, stress reduction is the very reason that some recommend not getting an HIV test. We would argue that the stress of an HIV test is worth it, while other stresses can be more easily eliminated at a lesser cost, both emotionally and physically.

The alternative is to stick your head in the sand and wait until you develop symptomatic HIV disease. There are early interventions available to those who learn their status when they have 1000 CD4+ T-cells and to those who learn their status when they have only ten. However, there are many more useful strategies that can be employed to enjoy a long and productive life if you learn your status early and act on that information right away.

There are some intrepid individuals who choose to use antiviral drugs before their CD4+ T-cell counts drop to 500. Aware that there is no life-threatening disease where physicians choose to wait for symptoms before they treat the disease, these individuals choose to fight the virus early. There are mixed reviews on the experimental evidence of such early antiviral intervention, but the reasoning is sound. And drugs that are currently in development may eventually be found to work best at higher CD4+ T-cell counts. Other individuals choose strategies without antivirals. Both are valid early responses and represent early intervention.

AIDS research has not come to a standstill. Progress is steady and continual. If you can buy more years of quality, symptom-free life by making early changes in diet, in exercise and rest, by stress reduction and the judicious use of antiviral strategies, you increase your chances that you will be around for the next advances in treatment that will eventually bring HIV disease under control.

Get tested. Intervene early. Learn your options. It is never too early (or too late) to take charge of your own health. t

ACT UP Golden Gate meets every Tuesday at 7:30 p.m. at 592 Castro Street, upstairs.

ACTion UPdate:

Abbott Labs is continuing to stonewall AIDS activists on provision of their protease inhibitor for compassionate use.

Call Abbott and demand they provide this experimental therapy to patients with few options left. Phone (708) 938-6277; fax (708) 938-4545.

Call ACT UP/Golden Gate for information on future actions at (415) 252-9200.
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Always watch for outdated information. This article first appeared in 1995. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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