Learning from the Living

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On paper, they are the lucky ones, the 10,000 or so children and and adolescents living with HIV in the United States. They have access to the latest anti-HIV drugs, powerful medications that can keep the virus at bay and, for all intents and purposes, keep them alive long enough for them to date, attend college, marry, and start families of their own. They are indeed fortunate — although living with HIV, even in the U.S., remains a challenge. But these young pioneers — many of them among the first to test antiretroviral (ARV) medications against HIV — are teaching doctors valuable lessons about how best to treat young patients affected by the disease. Their lessons, learned the hard way through painful trial and error, will spare millions of children in the developing world from treading the same difficult path.

At least that's what patients like Cristina Pena hope for. Now a 22-year-old college student in Los Angeles, Pena was infected at birth by her mother, who was unaware that Pena's father, now deceased, had transmitted the virus to her before she became pregnant. Pena knows nothing but living with HIV, although she didn't always know what HIV was. When Pena was young, her mother told her that the medications she took every day were for ear infections, and, Pena says, "you believe your parents." When she was nine, she finally asked her mother about the drugs and learned the truth. "I had started on AZT at five, and throughout my childhood, I was on various studies of new medicines, like 3TC. I was a complete test case," she says. "I had spinal taps, fluid checks, brain scans, bone density scans; you name it, I've done it."

After learning about her HIV status, she says she definitely started taking her medications more seriously. "But it was an ongoing struggle. I did feel sick most of the time — I had nausea and diarrhea. The medicine gave me a bitter, bitter, bitter taste that would come back up in my throat hours later in school. If I could get away with not taking them, I would." Knowing the truth also meant that Pena began living a double life. Only her closest friends knew her diagnosis; most of her classmates were unaware of the daily battle she fought with HIV. "I was worried if I was going to graduate," she confesses. "if I was going to make it to prom — everything was if, if, if, if. It was like I had a new life that I had jumped into, and I was wearing different costumes at different times."

When the protease inhibitors became available in 1996, Pena was one of many young AIDS patients who jumped on them. Since childhood, she says, the number of drugs that she took just continued to get larger and larger. "There were more pills at every birthday," she says. "As my weight increased, they would up the dose." The protease inhibitors were powerful but the side effects were brutal. "Since I was on medications for so long, it almost seemed like second nature to lose my appetite and be nauseated," she says.

Because of those side effects, Pena, in consultation with her doctor, has decided to stop taking her medications for a while, but anticipates she will have to go back on them soon. While she realizes that her decision is controversial, and not for everyone, she notes that since she is part of the first generation of kids who will spend their lives taking ARVs, they and their doctors will also have to take responsibility for what their lifelong regimen looks like. "There is an ongoing battle between researchers and HIV," she says, "and there is still much trial and error. Everything keeps changing. Treatment has changed, and the way people look at treatment has changed. And caught up in between are everyone's individual lives. We all have so much to learn from one another, and I don't think that there is a master pla n or treatment that will work for everyone."

What will work for anyone affected by HIV, however, is learning how to find strength and hope from each other. "I just want other people with HIV to know that it doesn't stop me from reaching my goals in life," says Alisha Saleem, 20, a Florida college student who has lived with HIV for her whole life. "If you have a strong, positive attitude, you know that you can still achieve anything whether you have the illness or not. I take my medicines every day, and it's hard. Sometimes I don't want to take them, but I know I have to. I want to educate other teens and adults out there about how HIV positive people can still be normal, and act normal." By living successful lives as normal teens, girls like Saleem and Pena are doing much more that - they are living beacons of hope for the millions of children born with HIV in the developing world.