The lives of two men in neighboring Southern cities illustrate the news—good and bad—from the World AIDS Conference in Geneva. The good news is that mortality from AIDS complications continues to drop and that many people on combination therapy are healthier than they have been in years. The bad news is that the advances in treatment have passed others by with little effect.
Originally published in The Advocate.
THE AFTERNOON LIGHT HAS AN AFTER-THE-STORM QUALITY as Douglas Ruhren steps out of his Italianate Georgian home in Durham, N.C. Framed by 90-year-old oaks, his yard is a tangle of native and exotic plants: pinkroot, angel’s trumpet, Miss Robb’s bonnet. It’s clear the lanky 42-year-old Ruhren, a professional gardener of some local renown, is most at home among his plants and that he hopes to be landscaping for a long time. “I’m the type of person who doesn’t want to retire when I’m 65 because I love what I’m doing.”
Three years ago it would have seemed unimaginable that Ruhren would live to age 65. Diagnosed with HIV in the mid-1980s, he suffered a series of opportunistic infections in 1995 that worried his friends and doctors. He came down with Pneumocystis carinii pneumonia twice, landing in the hospital during the second bout. “At that time the doctors came in under the cover of darkness and asked me if I wanted to be resuscitated if I stopped breathing,” Ruhren recalls. His T-cell count had fallen below 10. “It was a struggle, the three or five steps from the hospital bed to the bathroom. Still, I didn’t have a feeling it was the end.”
Ruhren was right. At the end of that year he completed a double-blind drug study in which he had been receiving the placebo. The researchers switched him over to the actual drug, a protease inhibitor. Ruhren’s T-cell count edged up to 11, then 50, then eventually 400. He added a second protease inhibitor, which he takes as part of a “cocktail” with two other antiviral drugs. Now his vital load is barely detectable.
“I feel probably as good as any 42-year-old person could feel,” Ruhren says. Not only has his energy come back, but he’s also regaining muscle tone. Even his sinusitis, common among people with weakened immune systems, is receding. Now a full-time freelance garden designer, he’s as busy—and as happy—as he’s ever been.
Ruhren has no illusion that he’s cured. “I’ve done every drug that’s come down the pike,” he says, “and each one has bought more time for something better.” Others, though, are less measured with their words. “If you think of HIV as a raging fire, we put out the fire,” said researcher Martin Markowitz during the 1996 AIDS conference in Vancouver, Canada. Words like cure have started creeping into the epidemic’s vocabulary. One recent study at Johns Hopkins University showed that 39% of gay men had engaged in unsafe sex over the previous six months, in part because they believed the protease inhibitors were a cure or near cure for AIDS.
In fact, not only are protease inhibitors not a cure, but for some people they simply haven’t worked. Two miles from Ruhren’s house, 43-year-old Mitch Foushee sits in a waiting room at Duke University Medical Center. On this June day he’s starting a new three-drug cocktail, this one designed for patients with high viral loads. Foushee is hopeful, but in a sober kind of way: So far none of the protease inhibitors he’s tried have lowered the HIV level in his bloodstream. “Those of us with high numbers never seem to benefit from the mix,” he says.
Before he retired 2½ years ago, Foushee was legislative director for Sen. Jeff Bingaman (D-N.M.), but when he was diagnosed with AIDS, “I realized I could not keep up with the Senate schedule.” He moved from Washington, D.C., to Chapel Hill, N.C., where he does part-time teaching and political consulting.
Even that is sometimes too much. Several months ago Foushee was hit by a fungal infection and had no immune system to fight it off. Doctors had to remove his left eye; today, he wears a patch over the socket. Both the infection and the treatment have left him too exhausted to work. His vanity has taken a hit too. His six-foot frame is down to 116 pounds, and even though his vision remains good, his missing eye has been a source of frustration. Foushee recalls a recent visit to a Chapel Hill restaurant: “I’m sitting at Dip’s, and my patch pops, and it’s sitting in my gravy, and there were 25 people watching. I ruined their dinner.”
Foushee hopes that by the end of the summer he’ll be able to teach again. And he hopes he will find the right drug combination to start eradicating his HIV. “The toughest thing is going from the Senate, where you’re working 18-hour days and you’re traveling, and suddenly all that ends,” he says. “That took getting used to. But I have refused to accept the terminal aspects of the disease.”