The Value Of Vigilance
ON A FRIDAY MORNING THIS PAST MARCH, JACK* WALKED INTO THE FIRST FLOOR OF AN OFFICE BUILDING AT DENVER’S ROSE MEDICAL CENTER FEELING A BIT FOOLISH.
His regularly scheduled appointment had been on the books for earlier in the week, but he’d had to reschedule. Jack had attempted the four-hour drive from his home just over the Kansas state line even though a powerful winter storm—a rare event known as a bomb cyclone—had been sweeping across the Front Range and the Eastern Plains. State patrol had closed the highways, so Jack navigated onto back roads. About an hour outside the city, the wind blew his vehicle into a ditch, and he had to spend the night in his car. The National Guard helped dig him out the next morning. In hindsight, Jack acknowledged it was reckless to have made the trip in that weather. But, he says, “it was important for me to be at that appointment.” After all, doctor visits at the Rocky Mountain CARES HIV clinic had saved his life.
Roughly two years earlier, in late summer 2017, Jack had gotten sick. He’d caught a lung infection and began losing so much weight that his five-foot-nine-inch frame withered to a skeletal 94 pounds. He couldn’t figure out what was wrong, and the physicians at a nearby medical center couldn’t either. It shouldn’t have taken a two-week stay in the ICU at a hospital in Hays, Kansas, for Jack to learn he had HIV, but it did. And it was almost too late. Doctors measure HIV, or human immunodeficiency virus, by counting the number of CD4 white blood cells in the body. Healthy individuals’ counts typically range between 500 and 1,500 cells. Anything lower indicates a severely compromised immune system—the hallmark of HIV. A count below 200 triggers an official diagnosis of AIDS (acquired immunodeficiency syndrome), an advanced-stage condition of the infection. When Dr. Ken Greenberg, an infectious disease specialist in Denver to whom Jack was referred, started seeing Jack, his CD4 cells numbered well below 100.
Fortunately for Jack, contracting HIV is not the one-way road it used to be. Since the emergence of the disease in the United States in the 1980s, advancements in treatment options have been nothing short of extraordinary. Back then, patients frequently lost 50 years to the disease, even while taking drugs that often had debilitating side effects. Today, the life expectancy of a patient with HIV is nearly the same as that of a healthy adult. The modern drugs are so good they’ve essentially turned what was once a death sentence into a manageable chronic condition. But that overwhelming success has had other, less-desirable effects, too: Because the mortality rate of HIV in the U.S.
