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This time, gentle readers, I have but two bees in my bonnet, as related to living with HIV: Ritonavir and testosterone. So, without further ado...
But even worse, the capsule form of Ritonavir proved to be chemically unstable. Now the drug is only available in liquid form — a foul, corrosive li-quid that is easily the worst thing you will ever taste. And if your AIDS cocktail includes it, you will taste it twice a day, every day.
I knew what I was getting into when I began taking Ritonavir, of course. Its liquid formulation is notorious in the HIV-positive media and has actually generated a lot of discourse, mostly in the 'helpful hints' vein. Mixing it with chocolate Ensure, priming your taste buds with peanut butter, taking it with yogurt are all popular suggestions. At best, these tactics slightly dilute the unspeakable taste of the stuff. But we take what we can get.
After taking the Ritonavir liquid for a couple of months, I caved in. I begged my pharmacist and my doctor for an alternative. I couldn't stand it anymore. The quality of my life had been significantly reduced by my twice-daily ordeal. However much peanut butter I crammed into my mouth, however tightly I pinched my nose, the nauseating aftertaste of the liquid would linger for hours. I plunged into gloom whenever I thought of my next dose. You may think I am exaggerating. I am not. Anyone who has tried this stuff knows exactly what I'm talking about.
I remembered that my doctor had once mentioned something to me about putting the Ritonavir liquid into capsules myself. He had warned me that it was labor-intensive and time-consuming and probably a big pain in the ass. I had taken his word for it, but after two miserable, poisonous months, I was willing to try anything.
My doctor was right; filling my own Ritonavir capsules is a big pain in the ass. Each gelatin capsule ($15 for 100, which insurance won't cover) needs to be filled with a syringe — a very delicate operation. Each 5ml dose takes six capsules to accommodate and that takes about 15 minutes of preparation time.
But guess what? It's easily worth it. I feel like I'm cheating the devil every time those six capsules slide down my throat. I still grapple with the side effects of Ritonavir, of course, but the experience of taking it has been downgraded from a genuine horror to a mere inconvenience.
I want to get two things across to two different groups of people. If you are HIV-positive and taking Ritonavir orally, I strongly encourage you to try putting the liquid into capsules yourself. If you are an AIDS practitioner, please take my word for it that this medicine tastes as bad as we say. Get your HIV-positive patients to try filling their own capsules. Living with HIV is hard enough without fouling your sense of taste twice a day.
Scientific studies have linked low levels of testosterone in HIV-positive men to depression, fatigue, and diminished sex drive. If you are experiencing any of these, you might want to have your testosterone levels checked.
It is important that your test is done correctly. To accurately gauge the levels of the hormone in your blood, three samples must be taken at 20-minute intervals. The samples are then combined and measured for testosterone content. This elaborate procedure is necessary because men's bodies naturally secrete quickly fluctuating amounts of the hormone.
As long as you're having blood drawn anyway, you should probably get your cholesterol level checked, too. Protease inhibitors have been shown to elevate cholesterol and testosterone can also sometimes boost it, so you and your doctor should monitor your relative levels carefully. Now that people are living longer with HIV, we need to attend to the long-range consequences of our medical treatment.
Testosterone is available either through injection or in patch form. The shot is medium-painful, but the patch is awkward to apply and difficult to keep in place. My partner and I get nurse's appointments at the Community Health Center every other week for our shots. They even keep our testosterone for us, so we don't have to worry about storing it.
If you want to undergo testosterone supplementation, however, you must commit yourself to getting shots regularly and without fail, as well as rigorously monitoring your testosterone and cholesterol levels. Like putting Ritonavir in capsules yourself, it's a bother, but you might feel much better if you do.
