Cocktail Hours

The latest AIDS medications give life to the dying--but what kind of life?

At 43, Shaffer is a long-term survivor, which is the true source of much of his pain. "People who began treatment 10 to 15 years ago are in the worst shape today," says Dr. Louis Sloan, a Dallas infectious disease specialist with a high volume of HIV/AIDS patients. "Not only because their immune system may be more damaged, but also because we didn't have the medicines back then that we do now."

When Shaffer was diagnosed with AIDS in 1993, he was a marketing director for a physical therapy clinic. He had no symptoms but agreed to get tested to induce his best friend, who he felt was "very promiscuous," to do the same. "He turns out to be negative, and I am the one who was positive," Shaffer says. "I was devastated."

He then submitted to another blood test, which counts the number of T-cells in a drop of blood. T-cells are a type of white blood cell that directs the immune system to fend off disease-causing bacteria, parasites and viruses. HIV, a cagey virus, hides from these T-cells before seeking them out and invading them. The virus then forces each infected cell to do its bidding by making millions of deadly copies of itself. It then mercilessly kills off each infected T-cell, whose reduced numbers indicate the amount of damage done to the immune system. A normal count is anywhere from 500 to 1,500 T-cells in a cubic millimeter of blood (about a drop). A person with a T-cell count below 200 has already progressed to full-blown AIDS. Shaffer tested at 150. "I was told I had six months to live."

Melissa Grove, the executive director of Legacy Counseling Center, the largest provider of HIV counseling services in Dallas, says that "HIV puts a magnifying glass on every other problem you have, bringing out existing issues and adding another layer of stress to them."
Mark Graham
Melissa Grove, the executive director of Legacy Counseling Center, the largest provider of HIV counseling services in Dallas, says that "HIV puts a magnifying glass on every other problem you have, bringing out existing issues and adding another layer of stress to them."
Dr. Louis Sloan, a Dallas HIV specialist, says that approximately 30 percent of patients do not take their cocktails with the discipline that the medications and the disease require. "It will catch up with them," he says. "But you can't convince them that five years from now they might have a problem."
Mark Graham
Dr. Louis Sloan, a Dallas HIV specialist, says that approximately 30 percent of patients do not take their cocktails with the discipline that the medications and the disease require. "It will catch up with them," he says. "But you can't convince them that five years from now they might have a problem."

He had gone to great lengths to minimize his risk, as did the vast majority of the gay community whose obliging response to the safe-sex message was a triumph for public health in this country. Although he never believed public pronouncements that AIDS was a "gay plague," he stopped drinking and doing the club scene, stopped having anal sex, unprotected or otherwise, and started dating married men exclusively. At least 20 of his friends would die from the disease, and his daily habit of perusing the obituaries made him treat everyone as if they were positive. "Before I went out with anyone, I would ask to see their test results."

Little did he realize that he was already positive, had been since the mid-'80s. He had come out when he was a teenager, he says, when being gay was more like entering a secret society, one with its own language, culture and nightlife. He was drawn to that life, dancing until morning at Bayou Landing, a popular Dallas club where gays and straights mingled without inhibition. Too possessive to have a long-term relationship, he instead had a long string of lovers. He used sex as a challenge, a celebration, a way to feel good about himself. "It was like a game with me," he says. "I knew how to fix myself, and that was through conquest." He met new men wherever he went: at gas stations, in grocery stores, outside clubs. It fed his ego to have them; it also gave him AIDS.

His first symptoms nearly cost him his life. Two months after testing positive, he developed an opportunistic infection in his intestines that required surgery. He could no longer work and went on disability. His former employer continued to carry him on its health insurance for a year, but the insurance provider refused to pay for a new medication on the market, AZT, which it considered experimental. AZT (a nuke), the first drug developed to fight HIV/AIDS, works by interfering with an enzyme that the virus needs to create new copies of itself. Suddenly there was a wonder drug that could save Shaffer's life, but he couldn't afford it. The state had devised a lottery to dispense the drugs to a fortunate few, but he couldn't wait. "I bought some through the black market," Shaffer says. "There are patients out there who refuse to take their medicine and need money. You just have to find them."

Regrettably, AZT was not the medical miracle it promised to be. During the three years he took it, Shaffer's T-cell count dropped to six, and he fell victim to pneumocystis carinii pneumonia (for which he was hospitalized four times), tuberculosis (for which he was quarantined), shingles, anemia and neuropathy so unbearable even morphine failed to ease the burning and stinging in his nerve-damaged feet. "Some people thought the AZT was killing us," he says. "Too many people were dying while they were on it."

The problem was, AZT was no cure and acting alone not particularly good medicine. For a time, it would compromise the virus, but it would never completely suppress the viral load--the number of copies of the virus in a drop of blood. Eventually, HIV would mutate into another strain that was not only resistant to AZT but was also cross-resistant to similar drugs within the same nuke class that were being rapidly developed.

Because of his resistance, Shaffer qualified for a clinical trial to test the effectiveness of Norvir, one of a new class of drugs called protease inhibitors. Much like AZT, these drugs prevent the virus from replicating by inhibiting the action of protease, another vital HIV enzyme. When taken as part of a HAART cocktail of nukes and later non-nukes, they would blast the virus into submission. Though the virus still remained hidden in "safe sanctuaries" such as the brain and the lymph nodes, these cocktails could make HIV virtually undetectable in the blood. "Protease inhibitors literally saved my life," Shaffer says. "For the first time, I wasn't susceptible to opportunistic infections."

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