(RITA!) HIV Treatment Alerts - May 2003
Rich Arenschieldt

When making presentations on HIV treatment issues, I always end with the same line: "These are the things you should know if you get hit by a bus." I realize that this may sound a bit unusual, but there's a method to my madness.

"Me? Get hit by a bus?" you might ask. Okay, that probably won't happen, but it is a metaphor for something that might. While our bodies are designed to provide some advance warning (pain, swelling, bleeding, etc.) if something serious is about to occur, there are certain situations (such as a sleepy bus driver) that provide little or no advance warning of danger.

As a result of talking with many HIV+ people, I've realized that many have, in some ways, put their HIV on a mental "back burner." In some ways this is natural—HIV should not be the single thing that defines anyone. However, there are risks associated with not fully addressing the role HIV plays in your life.

Here's a scenario:
Pete is building an outdoor, elevated deck. He is at home working by himself and inadvertently slips off the deck, lands on his head, and becomes unconscious. A passerby witnesses the accident and calls 911. Pete is transported to the hospital. An MRI is done and the doctor determines that he has a slight brain trauma that is serious but, under most circumstances, not life threatening. During surgery, a routine dose of anesthetic is given. Later, the patient enters into a coma for no apparent reason.

So what happened here?
A couple of coincidences occurred resulting in a disastrous outcome. First, Pete is HIV+ and taking medications that include Norvir, a protease inhibitor that increases the length of time most drugs remain in your body. Norvir, used in some combinations of anti-HIV therapy, is great at helping other HIV meds work better (it helps them stay in the body longer). Unfortunately, Norvir has the same effect on some other medications (such as anesthetics) as in Pete's case. Essentially, what happened to Pete is that the anesthetic he was given remained in his body longer than necessary because he was taking Norvir as part of his anti-HIV drug regimen. The increased level of anesthetic resulted in a coma.

What could have been done to prevent this?
Obviously, Pete could have been more careful and not done something so risky alone; but everyone has klutzy moments now and then. More importantly, there should have been a way to notify emergency medical personnel of Pete's medical information.

Preparation for accidents and emergencies requires a bit of advance planning. This does not mean you should have a tattoo on your forehead that says "HIV+: Handle With Care." A good solution can be far more discreet. According to Dr. Ben Barnett, an assistant professor of medicine at The University of Texas Houston Medical School,

"In an emergency medical situation, basic information is absolutely critical. This would include a list of current medications, allergies, other present conditions such as hepatitis or anemia, and most recent T cell count. This information can be included on a wallet card, or you could simply carry the name of someone to be contacted in case of an emergency who would know this updated information."

However, there's no need to foster paranoia. So here are some common-sense suggestions to be prepared as an HIV+ person if you ever get hit by a bus, fall off a deck, or have any other kind of medical emergency:

• If you are involved in an accident and no family or friends are present, the Emergency Medical Technician (EMT) or physician may look in your wallet or purse to determine who you are. Keep an "In Case of Emergency Card" near your driver's license or other identification.
  
• As additional protection, you might want to wear a medical ID bracelet, necklace, or charm. These are available from your doctor or through some pharmacies. They can provide information (without disclosing your HIV status) or a phone number to call for additional information. These can be purchased for as little as $10.
  
• According to a local EMT who is also a Center for AIDS volunteer, if called to your home an EMT will usually look in your refrigerator to find any medicines that you might be taking. Here's the trick—in your fridge keep an empty prescription bottle (with no label) containing a rolled up piece of paper with your pertinent medical information written on it. An EMT will find the bottle, open it, read its contents, and take the necessary actions, including notifying other healthcare providers of your specific circumstances.

How The Center for AIDS (CFA) can help you to be prepared:
As you have probably noticed by now, there is a "Medical Emergency" card in this article. You can cut it out and use it right away. Also, The CFA has a laminator and we will be happy to laminate your card (for free) so that you can have it in your wallet or purse at all times. There are additional "In Case of Emergency" cards here at The CFA if you or someone you know needs one. Also, if you would like to order a Medical ID bracelet, The CFA has order forms you can use. Stop by and we will be happy to give you one.

If you are dealing with HIV, The CFA knows how it affects your life. We understand that you are in the middle of a juggling act to keep things in balance. We don't want to further complicate your life by bringing up these "emergency-oriented" topics, but they are important. As always, we would like to offer practical information to help you manage your health and well-being.

IN CASE OF EMERGENCY

My Name is ________________________________

In an emergency please contact __________________________

at ______________________ or ________________________

My Doctor is ______________________________________

My doctor's Phone Number is __________________________

I am allergic to: _____________________________________

                        _____________________________________

I am taking these medications: ___________________________

                                             ____________________________

                                             ____________________________

                                             ____________________________

Other conditions: ______________________________

                           ______________________________

Date I filled out this card: ______________________________

20030510
RI030503

Copyright © 2003 - Research Initiative Treatment Action (RITA!). Reproduced with permission. RITA! is published by The Center for AIDS. Contact Thomas Gegeny, MS, ELS, Editor, RITA! for permission to reproduce RITA!. tom@centerforaids.org. http://www.centerforaids.org

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