HIV positive results announced via text

[cellsaver]

As the title states, a friend sent me 5 text messages today back to back that left me dumbfounded. I am surprised of their HIV announcement via text. The texts provided a photo of their lab results reflecting "HIV Ag-Ab Reactive" and "HIV-1 Ab reactive", a few other labs which were unrelated to HIV and then a long drawn out text indicating how conflicted they were.

I am of the opinion that having Type 2 Diabetes is far worse than being HIV + in the 21st Century. Thankfully this is no longer the 1980s/90s. So I am not particularly concerned that my friend may be HIV positive. As long as they take their meds, they're good to go.

I am thinking of calling to discuss the wisdom of getting a PCR test to confirm, treatment options and and go from there. However, given that the next was sent via text, perhaps shame, guilt, denial, etc are involved and texting is their preferred method for now.

I loathe texting, social media, apps, etc. I think texting about something like this might be hiding. However, maybe hiding is in order?

As a physician in training with news from a friend like this via text, what would you do:

respond via text at length about the do's and don'ts for re-testing, treatment options, etc,

call on the phone to hash out the situation or

send an obligate emoticon and let them respond

I am baffled

---

Members don't see this ad.

 

[Brorthopedic]

I'm more concerned about you than your friend

 

[Doctor Strange]

Are you for real? Call your friend and talk it out. While HIV is certainly a manageable disease thanks to innovation in antiretroviral therapy, it is still a serious diagnosis that is terrifying to the general public. The amount of stigma attached to the diagnosis alone is enough to rattle anyone. Your friend is reaching out to you at a vulnerable moment right now, and you need to be a lot less callous than you're coming off in this post.

 

[deleted480308]

As the title states, a friend sent me 5 text messages today back to back that left me dumbfounded. I am surprised of their HIV announcement via text. The texts provided a photo of their lab results reflecting "HIV Ag-Ab Reactive" and "HIV-1 Ab reactive", a few other labs which were unrelated to HIV and then a long drawn out text indicating how conflicted they were.

I am of the opinion that having Type 2 Diabetes is far worse than being HIV + in the 21st Century. Thankfully this is no longer the 1980s/90s. So I am not particularly concerned that my friend may be HIV positive. As long as they take their meds, they're good to go.

I am thinking of calling to discuss the wisdom of getting a PCR test to confirm, treatment options and and go from there. However, given that the next was sent via text, perhaps shame, guilt, denial, etc are involved and texting is their preferred method for now.

I loathe texting, social media, apps, etc. I think texting about something like this might be hiding. However, maybe hiding is in order?

As a physician in training with news from a friend like this via text, what would you do:

respond via text at length about the do's and don'ts for re-testing, treatment options, etc,

call on the phone to hash out the situation or

send an obligate emoticon and let them respond

I am baffled

be a human and call your friend for emotional support

as for metting out "dos and don'ts", you don't do that. You're a med student. The only "do and don't" you hand out is, do go back to your doctor and heavily consider their treatment advice

 

[dpmd]

OP doesn't seem prepared to be callous with the friend. I don't really see anything wrong with them trying to figure out how best to respond given that texting a friend about bad news is sort of weird (at least it is to me but perhaps the younger crowd does things this way now). So it is reasonable to consider whether the friend is having trouble processing and therefore prefers to keep things in a written form (where they can respond at their leisure and think about their responses), or if a phone call is more appropriate. I would probably text them a sympathetic response and offer to talk more over the phone or by text whichever they prefer. That way they can decide but they know that I am available.

 

[SunsFun]

OP, comparing diabetes with HIV and stating that you're not particularly concerned about your friend is a bigger issue here. I suggest you focus on that first and then worry about proper means to communicate bad news.


Sent from my iPhone using SDN mobile app

 

[OnePunchBiopsy]

Reflecting everything above; call your friend and speak to them as a friend, not their provider.

 

[HopefulEMed]

Cellsaver, I tried to message you, but I think your settings are really restrictive. I know this can be really shocking/challenging time. I have worked with HIV+ patients extensively and I have friends that are in the 60s who were positive since the 1990s. It's not unusual for patients to feel numb/their friends to feel shocked. This period can last for a while. It can be a really challenging time. So, please don't hesitate to reach-out. I may be able to help. Thinking of you and your friend.

 

[XxThaDoggxX]

Reflecting everything above; call your friend and speak to them as a friend, not their provider.

Exactly this. Put medicine aside right now, just be a supportive friend.

 

[Goro]

*sigh* Millenials

As the title states, a friend sent me 5 text messages today back to back that left me dumbfounded. I am surprised of their HIV announcement via text. The texts provided a photo of their lab results reflecting "HIV Ag-Ab Reactive" and "HIV-1 Ab reactive", a few other labs which were unrelated to HIV and then a long drawn out text indicating how conflicted they were.

I am of the opinion that having Type 2 Diabetes is far worse than being HIV + in the 21st Century. Thankfully this is no longer the 1980s/90s. So I am not particularly concerned that my friend may be HIV positive. As long as they take their meds, they're good to go.

I am thinking of calling to discuss the wisdom of getting a PCR test to confirm, treatment options and and go from there. However, given that the next was sent via text, perhaps shame, guilt, denial, etc are involved and texting is their preferred method for now.

I loathe texting, social media, apps, etc. I think texting about something like this might be hiding. However, maybe hiding is in order?

As a physician in training with news from a friend like this via text, what would you do:

respond via text at length about the do's and don'ts for re-testing, treatment options, etc,

call on the phone to hash out the situation or

send an obligate emoticon and let them respond

I am baffled

 

[Stagg737]

I'd personally respond with a supportive text and ask if it's alright to call them. If they notified you with a text, they might not be ready to actually talk about it yet and may need a few days to process everything. Just let them know you're there to talk if they need support and that you're willing to be there for them (assuming you are).

And please, please, PLEASE do not send an emoticon. Why anyone would think that's appropriate in a situation like this is completely beyond me...

 

[Blessthefall]

As of right now, type 2 diabetes at least stands the chance of being reversed in some cases; HIV however, only in the rarest of cases, n=1. Incredibly insensitive of you to formulate that conclusion IMO. Be a human being to your friend and at least pretend to care- if only for their sake.

 

[neoevolution]

I'd personally respond with a supportive text and ask if it's alright to call them. If they notified you with a text, they might not be ready to actually talk about it yet and may need a few days to process everything. Just let them know you're there to talk if they need support and that you're willing to be there for them (assuming you are).

And please, please, PLEASE do not send an emoticon. Why anyone would think that's appropriate in a situation like this is completely beyond me...

I wouldn't underestimate the power of a well-placed emoticon.

is the ultimate expression of sorrow

 

[Stagg737]

I wouldn't underestimate the power of a well-placed emoticon.

is the ultimate expression of sorrow

The person's hamster didn't die, they've got a deadly disease. Emoticons/emojis are for "sad" things, not life-altering events.

 

[bannie22]

I dont think you are in a position to provide a listening ear if your assumption is that diabetes is a worse disease than HIV.

That comment is shocking.

 

[username456789]

I dont think you are in a position to provide a listening ear if your assumption is that diabetes is a worse disease than HIV.

That comment is shocking.

That's not a shocking comment at all.

I think I'm most shocked that people are shocked by the comparison.

It's not 1987 anymore.

 

[Drrrrrr. Celty]

That's not a shocking comment at all.

I think I'm most shocked that people are shocked by the comparison.

It's not 1987 anymore.

In more civilized nations with socialized healthcare it's a reasonable comparison. In fact the BBC recently published that HIV+ individuals these days have no difference in life span than non-infected individuals. However in the US metformin is pretty cheap. A good combination drug? Well, at least they aren't charging the same amount as they do for imatinib.

 

[ortnakas]

Exactly this. Put medicine aside right now, just be a supportive friend.

This. You're a friend, not a doctor. And even if you were a doctor, you're not your friend's doctor.

He/she needs a shoulder to cry on or a listening ear, not info on how PCR works or PCP prophylaxis or outcome numbers.

Call your friend and be there for them. MAYBE text an offer to meet up or chat on the phone, but whether you use technology or carrier pigeon, reach out as a friend, not a medical student.

 

[TheFutureFatMan]

Call because you're a friend. Text is impersonal and if this is someone you care about, you need to reach out in a personal way.

You're a medical student and shouldn't be providing any kind of medical advice short of: consult with your physician and follow their treatment recommendations.

Literally that is all you should ever say as a medical student.

 

[cellsaver]

That's not a shocking comment at all.
I think I'm most shocked that people are shocked by the comparison.
It's not 1987 anymore.

I am blown away by their comments as well.
Clearly there is a whole lot more work to be done in the medical community about HIV in the 21st Century.

 

[IslandStyle808]

That's not a shocking comment at all.

I think I'm most shocked that people are shocked by the comparison.

It's not 1987 anymore.

Yet metformin is way cheaper than anti-retrovirals. The financial situation also matters, as well as the stigma that comes with HIV.

 

[Drrrrrr. Celty]

As someone who has worked extensively with HIV patients...in terms of actual prognosis/medical management/physical health, you're not wrong. However, you can't discount the stigma that comes with HIV. The diagnosis could affect your future partners, kids, etc., people get fired and kicked out of housing for being HIV+. Whether or not the stigma is justified, it exists, and in that aspect it is way harder to have HIV than something like diabetes.

I'm somewhat concerned as to how a landlord can legally ask you to disclose your communicable disease statuses.

 

[cellsaver]

Thank you everybody for responding.

Here is what I wrote to my friend via text...the method I chose to use. However, I had to push myself to do so out of respect for their wishes

"mi amor. si quieres hablar conmigo por telefono tu sabes que estoy disponible. acabo llegar a la casa de la universidad y voy a cenar con (mi esposo). Si deseas hablar en una hora, avisame. Hay pocas personas que sepan mas que yo sobre VIH. Recuerdate que trabaje para la industria 11 años, y dirigia charlas sobre medicamentos de VIH en los 1990s y 2000/2001 con infectologos. Dejame saber. te quiero"​

translation: my love. if you wish to talk to me on the telephone, you know I am available. I just got home from the university and I am about to eat dinner with my (husband). If you would like to talk in one hour, let me know. There are few people who know more than me when it comes to HIV. Remember that I worked in the industry for 11 years and I used to lead discussions on HIV meds in the 1990s & 2000/2001 with infectious disease specialists. Let me know. I love you"​

My friend responded via text in a matter of minutes and called me exactly in 1 hour.

Shame. That is why the text was sent instead of calling me.

We spoke for 30 minutes, I discussed how HIV today is not like HIV in the 1980s, relayed data about life expectancy for HIV + individuals who are compliant with treatment, and how Type 2 Diabetes is far worse than HIV. I answered all of the questions put forth to me, while reinforcing over and over to see their IM physician right away. The physician and I both got the same texts. The physician is traveling across the country and will not return home until later this week. However the physician called immediately and said exactly what I said. My friend stated that their physician said: "you need to come see me right away when I return, have blood drawn to "count the viral load" (a PCR), and it it is confirmed, discuss treatment options."

this is a no-brainer....at least I thought most people knew this in the 21st Century

You folks really should be reading current diagnostic/treatment paradigms instead of that POS First Aid crap.

Establishing the Diagnosis of HIV Infection​

Reactive screening tests must be confirmed by a supplemental antibody test (i.e., Western blot [WB] and indirect immunofluorescence assay [IFA]) or virologic test (i.e., the HIV-1 RNA assay) A confirmed positive antibody test result indicates that a person is infected with HIV and capable of transmitting the virus to others. HIV antibody is detectable in at least 95% of patients within 3 months after infection. Although a negative antibody test result usually indicates that a person is not infected, antibody tests cannot exclude recent infection. Virologic tests for HIV-1 RNA can also be used to identify acute infection in persons who are negative for HIV antibodies.​

It was a beautiful telephone conversation and my friend told me they were "desperate" to talk to me but did not want to disturb me, knowing the physician was traveling. I responded, "please call me next time instead of texting me".

I am not a physician. I only have 25 years of clinical experience teaching physicians about treatment options for diseases like HIV. I'll have the MD in 1.5 years, but I will probably learn nothing new about HIV that I don't already know

However, I posted the thread because i was baffled about how my friend revealed their really important news. In my book texting such information is borderline pathology. Yet, texting is what people use today to communicate. I can't wrap my head around that. I just can't. And I won't accept texting as a substitute to real life face to face communication especially in matters such as these.

 

[Drrrrrr. Celty]

They can't, and it's also illegal to discriminate based on HIV status. However, some of the patients I've worked with have coincidentally been fired/evicted/etc. for "other" reasons shortly after someone found out they had HIV. There are also states where you can legally be evicted/fired for being gay, so this happened to one patients as well even though the landlord/boss had known for some time that the person was gay. And when this stuff does happen, people tend not to file lawsuits - it costs money they usually don't have, and would require them to risk their HIV status being known to more people and even potentially public knowledge.

This makes more sense.

 

[SunsFun]

OP, you're missing the point. Your comparison is uncalled for and inappropriately minimizes the dramatic way HIV diagnosis can and does affect peoples' lives.

Prion disease is worse than either, IMO. Doesn't make it appropriate to pull the "it could always be worse" card on someone who just got their positive HIV result.


Sent from my iPhone using SDN mobile app

 

[Drrrrrr. Celty]

Yea it's not shocking when you consider the user who posted it. You have to be out of your mind if you think a sexually transmitted, chronic, and sometimes life threatening disease is comparable to one that could basically be controlled with lifestyle and a medication that sometimes causes diarrhea, even when uncontrolled and not treated properly might not hurt you for a decade.

But yea put your hand on his shoulder and say don't worry bro, you just have a mild case of the HIV, won't be an issue explaining it to your future partner at all. It's like diabetes. It's not 1987.

There's no need to take what they're saying out of proportion. There is significance in normalizing people with HIV both to the infected and in the society. For a lot of people they still believe undoubtedly that an HIV+ individual is someone that will die in a few years. To be told that it's a chronic condition that has successful treatments is for many an enormous relief.

Metformin has plenty of side effects including similar ones to some NRTI drugs, for example lactic acidosis.

 

[Drrrrrr. Celty]

Dude, nobody was questioning your knowledge about HIV treatment or testing or whatever. The issue wasn't that you're not a doctor, it was that you're not your friend's doctor. You are their friend. If they asked you questions about the medical aspect, that's one thing, but you didn't indicate that to be the case in your initial post. And nobody was saying that HIV is a death sentence, either - just that there are other challenges to consider besides the medical prognosis. I've worked in HIV testing as well as case management for HIV patients. Just because there shouldn't be a stigma doesn't mean there isn't one.

Further, as someone who has a chronic illness you would probably consider to be worse than HIV, when I got diagnosed the last thing I wanted from my friends - even ones knowledgeable about the disease - was medical advice. And I would have been p/o'd if somebody told me "at least you don't have diabetes!" I needed support and empathy. That's the point that everybody was trying to make to you, and you apparently missed it by a mile.

That said, I'm glad you feel the conversation went well and I wish your friend the best.

I agree. Your friend needs a friend. Not someone who is going to parrot what their doctor said or will say. If they asked you about the disease, go ahead and answer, but you're there to offer support.

either way this topic is dead now.

 

[cellsaver]

As someone who has worked extensively with HIV patients...in terms of actual prognosis/medical management/physical health, you're not wrong. However, you can't discount the stigma that comes with HIV. The diagnosis could affect your future partners, kids, etc., people get fired and kicked out of housing for being HIV+. Whether or not the stigma is justified, it exists, and in that aspect it is way harder to have HIV than something like diabetes.

yes and no.

We know the road many T2D patients take: non-compliant, they start with metformin, and add on from there a host of oral meds there are available today that were not available 30 years ago... until they get to insulin sq. Along the journey their GFR declines, renal parenchyma takes a hit, neuropathy, retinopathy, etc, etc, etc.

HIV undetectable, CD4 count WNL, take 1 drug (of 3 or 4 meds combined) po q day, and you'd never know they are HIV positive.
With today's HIV meds, compared to the days of Fortovase, Invirase, Crixivan (drug from hell), having HIV is really inconsequential as long as they are compliant. Not so with T2D.

As to discrimination, yes. There is that. People discriminate HIV positive people once they know who is POZ. This is why my friend sent me a text instead of calling me: shame, secrecy, fear, etc.

Since you have worked extensively with HIV patients, you will recall the psyche of many HIV+ MSM who dealt with lipodystrophy, facial wasting, hump back, and plenty of self-loathing. Those were awful years.

 

[username456789]

Yea it's not shocking when you consider the user who posted it. You have to be out of your mind if you think a sexually transmitted, chronic, and sometimes life threatening disease is comparable to one that could basically be controlled with lifestyle and a medication that sometimes causes diarrhea, even when uncontrolled and not treated properly might not hurt you for a decade.

But yea put your hand on his shoulder and say don't worry bro, you just have a mild case of the HIV, won't be an issue explaining it to your future partner at all. It's like diabetes. It's not 1987.

Diabetes is a chronic and life threatening disease that goes poorly controlled in many, many individuals. The fact that diabetes is not sexually transmitted does not make it less concerning.

The rest of your fly-off-the-handle style strawman stuff is a nonstarter. I'll give you the benefit of the doubt and assume that you're simply letting your impression of the OP and his somewhat callous nature of delivery cloud your interpretation of an otherwise fairly reasonable opinion.

As you progress in your training, you'll realize just what a clusterf*ck diabetes can be.

 

[FutureDoc1088]

Hope you turned off read receipts so your friend doesn't know how long you've been thinking about your response... Call.

 

[cellsaver]

Yea it's not shocking when you consider the user who posted it. You have to be out of your mind if you think a sexually transmitted, chronic, and sometimes life threatening disease is comparable to one that could basically be controlled with lifestyle and a medication that sometimes causes diarrhea, even when uncontrolled and not treated properly might not hurt you for a decade.

But yea put your hand on his shoulder and say don't worry bro, you just have a mild case of the HIV, won't be an issue explaining it to your future partner at all. It's like diabetes. It's not 1987.

Your comments brought back memories of Anita Bryant, Jerry Falwell and the so called Moral Majority. They were powerful, paralyzing forces in the 1980s/90s who painted HIV + people as contagion. It is that type of fear mongering and painting with a broad brush that perpetuates the discrimination and prejudicial treatment of LGBT and HIV +. This is why my friend sent me a text message to announce their ELISA test results to me which are not confirmatory.

A person dx HIV+ 15 years ago who has been compliant with tx, has been undetectable for >10 years, and has a CD4 count >500 has a negligible to non-existent chances of passing on HIV....

No-one with an undetectable viral load, gay or heterosexual, transmits HIV in first two years of PARTNER study
When asked what the study tells us about the chance of someone with an undetectable viral load transmitting HIV, presenter Alison Rodger said: "Our best estimate is it's zero."

Frequently Asked Questions - Veterans Administration
Q: If taking anti-HIV drugs has made my viral load undetectable (meaning that the virus isn't showing up on blood tests), can I still pass the virus to another person through sex?
A: The research results available at this time show that our current HIV medication regimens (antiretroviral therapy, or ART) are very, very effective at preventing HIV transmission to a sex partner if the HIV viral load is undetectable.

RISK OF SEXUAL TRANSMISSION OF HIV FROM A PERSON LIVING WITH HIV WHO HAS AN UNDETECTABLE VIRAL LOAD
Messaging Primer & Consensus Statement
There is now evidence-based confirmation that the risk of HIV transmission from a person living with HIV (PLHIV), who is on Antiretroviral Therapy (ART) and has achieved an undetectable viral load in their blood for at least 6 months is negligible to non-existent. While HIV is not always transmitted even with a detectable viral load, when the partner with HIV has an undetectable viral load this both protects their own health and prevents new HIV infections.​

I have no issues with someone who is HIV+. Ive been known to respond to newly diagnosed HIV + people when they disclose their status with a simple, "and your point is....?" If they are compliant with treatment, it is a non-issue. The bigger issue is people like you painting them as contagion

It is really important to minimize any sense of worry, panic or dread in a newly dx HIV+ patient because the disease isnt what it used to be. They must be reassured over and over and over, "it's OK, you are going to be fine, you are not going to die, just take your meds and you will never get sick"

OTOH, in spite of the plethora of meds for T2D, diabetics get worse with each passing decade because of poor compliance. It is hard to believe that T2D patients are still advancing to amputation of limbs. There is no excuse for that today considering the huge arsenal of meds available. HIV+ patients are far more motivated and compliant than T2D patients and hence don't succumb to PCP, KS, Toxoplasma gondi, etc, etc, etc like they once did. Those that do do so only because they are non-compliant.

Since you are not a student of medicine but rather someone who posts on SDN as a spectator throwing out barbs, I don't expect you to take anything I just wrote to heart. In fact I did not respond to you for your sake. I wrote for the others. People like you force newly diagnosed HIV+ patients into dark spaces of fear, anxiety and suicidal ideals. My friend is a public figure, in a position of high visibility and can not have open discussions about their recent health news. But they were so caught up in fear and self-doubt that they felt texting was their only means of announcing their news to both their physician and to me, a close friend of many years who happens to have a boat load of clinical experience in HIV. So when we spoke, all I really told them, "you're going to be OK. You're not going to die. Tell me about your symptoms, when you started to feel sick, what made you get the ELISA test, what your plans are, etc". Not once did i ask, "what did you do to merit this diagnosis?" None of my business and totally irrelevant.

HIV positive people aren't the threat. It is the fear mongers who threaten HIV + people, which is why I spent a half hour reassuring my friend, that they are loved, they are welcome in my life, that I do not fear them, and they are to tell no one of their condition precisely because of people like you.

Get informed buddy. You are doing no one any favors by portraying HIV + people as individuals who can spread an STD. If they are undetectable, they can not.

 

[jcorpsmanMD]

*sigh* Millenials

Not all of us are this neurotic, I promise

 

[cellsaver]

Hope you turned off read receipts so your friend doesn't know how long you've been thinking about your response... Call.

they live in Latin America. no read receipts and it's a whole different culture out there re: HIV.

 

[cellsaver]

Not all of us are this neurotic, I promise

LMBO. good one.

FWIW, my friend is in their 50s. I'm not too far behind

 

[cellsaver]

Metformin has plenty of side effects including similar ones to some NRTI drugs, for example lactic acidosis.

Metformin has a very low rate of lactic acidosis.

Metformin-associated lactic acidosis: Current perspectives on causes and risk. 2016. DeFronzo, Ralph et al., Metabolism - Clinical and Experimental , Volume 65 , Issue 2 , 20 - 29

With approximately 50 years of accumulated real-world global clinical experience, metformin is generally regarded as safe with the most frequent adverse effects being gastrointestinal in nature: diarrhea, nausea, and to a lesser extent, vomiting [[2], [3], [4]]. In particular, metformin is less well tolerated in patients with preexisting gastrointestinal conditions [5].

Metformin is contraindicated in patients with renal or hepatic insufficiency, in very elderly patients, and in patients with conditions of circulatory dysfunction such as congestive heart failure, due to increased risk of lactic acidosis [6]. Though metformin-associated lactic acidosis (MALA) is an extremely rare condition (most estimates are ≤10 events per 100,000 patient-years of exposure), cases continue to be reported and are associated with mortality rates of 30 to 50%​

It's not the drugs that worsen the quality of life of TD2 patients. It's their lifestyle choices (e.g. obesity).
As for HIV+ patients, most are meticulous about their health. They know what will happen if they lower their guard.
Not so for T2D patients.

 

[Señor S]

Diabetes is a chronic and life threatening disease that goes poorly controlled in many, many individuals. The fact that diabetes is not sexually transmitted does not make it less concerning.

The rest of your fly-off-the-handle style strawman stuff is a nonstarter. I'll give you the benefit of the doubt and assume that you're simply letting your impression of the OP and his somewhat callous nature of delivery cloud your interpretation of an otherwise fairly reasonable opinion.

As you progress in your training, you'll realize just what a clusterf*ck diabetes can be.

And HIV is what exactly? Do you want to compare outcomes for Type II diabetics vs. HIV+ pts where both are non-compliant?

This board has officially gone off the rails.

 

[username456789]

And HIV is what exactly? Do you want to compare outcomes for Type II diabetics vs. HIV+ pts where both are non-compliant?

This board has officially gone off the rails.

Read the post to which I was replying. I was pointing out that exact similarity between the two. Using the same words he used describe to HIV.

Thank you for helping me to make my point.

And no, it would be silly and pointless to compare what you're suggesting. I am not concerned about medication compliance for the two populations. What I'm concerned about is that there is significant lifestyle modification that is probably more important than medication compliance for diabetes. Unfortunately, we all know how that turns out.

Are you guys even learning medicine? Maybe it's just that you haven't actually seen what happens in the real world yet. unfortunately, the people talking about the stigma are absolutely right, because it's clear even medical students have a poor understanding of the progress we have made with the disease and rest heavily upon historical sensationalism.

 

[Señor S]

Read the post to which I was replying. I was pointing out that exact similarity between the two. Using the same words he used describe to HIV.

Thank you for helping me to make my point.

And no, it would be silly and pointless to compare what you're suggesting. I am not concerned about medication compliance for the two populations. What I'm concerned about is that there is significant lifestyle modification that is probably more important than medication compliance for diabetes. Unfortunately, we all know how that turns out.

Are you guys even learning medicine? Maybe it's just that you haven't actually seen what happens in the real world yet. unfortunately, the people talking about the stigma are absolutely right, because it's clear even medical students have a poor understanding of the progress we have made with the disease and rest heavily upon historical sensationalism.

Chronic, life threatening and poorly controlled are descriptors that could be (meaninglessly) applied to all sorts of conditions. By that "logic" I could say that having asthma is basically the same as having COPD. Your post is borderline incoherent, as was your previous "fly off the handle strawman" post above; you're just throwing around random terms you've heard in other online debates without any clue as to what they mean.

The real world? JP2740 is a second-year IM resident; you're a dermatologist repeating a meme ("HIV is just another chronic illness") you heard during your internship, a meme that needs to go away as it trivializes what is still a very serious disease. HIV is only comparable to TIIDM (or "far worse" (!), as the OP put it) if you're intentionally being autistic about it.

 

[cellsaver]

<rant>

 

[cellsaver]

Are you guys even learning medicine? Maybe it's just that you haven't actually seen what happens in the real world yet. unfortunately, the people talking about the stigma are absolutely right, because it's clear even medical students have a poor understanding of the progress we have made with the disease and rest heavily upon historical sensationalism.

I asked a senior Cardiologist at our institution if he would see a HIV patient who is having a difficult time controlling LDL/TG levels. His response? "Why me? I'm not an HIV doctor"

I quickly ended the conversation, asked another senior Cardiologist who said, "sure, no problem"

For this thread as the OP, I asked a simple question as to "communication" habits in today's world. My husband and I have discussed this issue at length (texting HIV results versus calling). I feel worse and worse for my friend because clearly, if this "medical student" crowd can't get their heads out of their arses with the plethora of data (see above my links), then truly HIV+ people have more fears than their viral load....dahyum!

 

[ridethecliche]

OP, comparing diabetes with HIV and stating that you're not particularly concerned about your friend is a bigger issue here. I suggest you focus on that first and then worry about proper means to communicate bad news.


Sent from my iPhone using SDN mobile app

Disagree with the text in bold. I've heard several ID attendings say the same thing.

 

[cellsaver]

Disagree with the text in bold. I've heard several ID attendings say the same thing.

ID was a field that was busting in the 1990s. Those ID docs were true heroes. The things they saw left them speechless and they could do nothing for their HIV patients. They were amazing men and women approaching really sick patients who were broken and the physicians then became their advocates. Many of them went into public health because they saw the travesty of what HIV did to our culture. Today? Their ID jobs are nothing like the 1990s. Nosocomial infections are more pressing for ID docs than treating HIV.

There are multiple meds on the market that are essentially one pill for an HIV + person. One pill will contain 3 or 4 medicnes. That is staggering. Compare this concept to Fortovase, the first PI on the market....1200 mg tid. The gel capsules were formulated in 200 mg. So the HIV + patient on Fortovase took 18 capsules per day....just for one lousy PI. Think about that: 18 gel capsules for one class of drug - first generation PIs - with horrific ADs. Their LDLs were all over the place, not to mention the other physical effects.

ask those ID Attendings about their HIV + patients who are "long term survivors", CD 4 > 500, viral load undetectable > 10 years, and ask them what causes their death? T2D, Hyperlipidemia, HTN, CA, smoking, etc, etc, etc... sound familiar?

You just don't see KS, PCP, Toxoplasm, etc, etc, etc in HIV patients as nearly as much as 15-20 years ago. Then again, if the audience learns medicine from FA, then why should anyone be surprised at their ignorance of HIV rates in the 21st Century?

 

[ridethecliche]

I'm really not sure what your point is because I was agreeing with you somewhat-ish. Doesn't make it a less controversial thing to say though.

We had lots of diabetic patients come in for ID appointments because they had peripheral neuropathy and didn't realize there was an issue going on till their toes started falling off. This was a relatively extreme case that I remember for that exact reason, but I saw lighter shades of this issue quite a few times.

 

[hopefulERdoc251]

lmao OP as a physician:

Sir you have HIV, sack up or pack up, at least you don't have T2D.

Oh boy.....

 

[FutureDoc1088]

Protease inhibitors could cause diabetes, so I think HIV is worse based on the arguments presented...

 

[cellsaver]

I wanted to share some good news about my long distance friend with the HIV diagnosis. The individual is seeing an HIV Specialist, was started on ART, and Bactrim because their CD4 was < 20, Viral Load over 300,000, and had had pneumonia months prior. It appears my friend was full blown AIDS which surprised them, but it was something I feared. This person lives outside the continental US but in a US Territory hence they have access to treatment, but cultural stigma exists

I was also shocked that their primary care physician refused to initiate treatment. The cultural prejudice is so punitive, my friend had to wait more than 45 days to see an HIV Specialist knowing their dismal numbers. I was thankful my friend prevailed upon their PCP for an Rx of Bactrim to prevent PCP

Their HIV physician received my friend with open arms, is very supportive and was a former member of their church. It took great courage on the patient's part, and great compassion on the HIV Physician's part to have such a wonderful ending. A happy ending....thankfully caught in time

 

[cellsaver]

We had lots of diabetic patients come in for ID appointments because they had peripheral neuropathy and didn't realize there was an issue going on till their toes started falling off. This was a relatively extreme case that I remember for that exact reason, but I saw lighter shades of this issue quite a few times.

It is always upsetting to me to see T2D patients who progressively get worse. Most don't cooperate with nutritionally sound meals, dont lose the weight and dont exercise. All this in spite of taking their metformin and other meds. As we all know T2D is a difficult illness when the patient wont participate in their tx.

I recently saw a "long term survivor" HIV+ patient, in their 50s, in ID Clinic. Patient is 20 years HIV+, undetectable as long, BMI 26, BP 110/70, no etoh, no smoking, no drugs, normal cholesterol, exercises, nutritionally compliant, was seeing their physician once every 6 months for labs but has been bumped back to once a year. A model patient.

That is the new patient profile of an HIV + patient. Take one pill, and all is good. Type 2 Diabetes can be a very different scenario regardless if they take their meds...