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A New Beginning for HIV Patients

By Dr. Ram Prakash Thirugnanasambandam

“Is it true that there is an injection for HIV now?”

This is a common question many patients have asked me at the outpatient clinic over the past six months. It felt like a dream come true for most of my patients who had been taking daily medications since their diagnosis. To me as well, it was a remarkable advancement in the treatment of this disease, which has defined much of my J-1 physician training experience thus far.

I applied to the STAR (Special Treatment and Research) HIV specialty track in my institution as part of my internal medicine residency when I joined as an intern. I had never had the opportunity to see and treat patients with HIV while in medical school in India. I realized that this was an opportunity to learn more, not only about HIV but also about my patients’ experiences. My patients come to a specialized clinic at my hospital where we play dual roles as physicians: we manage and treat their HIV as infectious disease physicians while treating their other medical issues as primary care physicians. It has become one of my favorite parts of my training. Interacting with and treating my patients has taught me so much. I learn medicine at a specialty level and form close bonds with my patients, who tell me all about themselves while revealing their history and experiences of living with HIV.

The STAR track residents and attendings

Many of my patients encountered various traumatic experiences once diagnosed with HIV. While already contemplating the uncertainty of how long they would live and what their quality of life would be with this disease, they also dealt with the burden of disclosing their diagnosis to their loved ones, the fear of being rejected by their family and friends, constant worry about being able to afford medications and proper care, and above all the social stigma that comes with being identified as a person with HIV. My patients often recall their initial struggle with getting the medications needed to survive. Many of them have seen close friends die due to the non-availability of these life-saving medications. There have been many advancements with these medications in the past several years, including the transition from doses involving a dozen pills to just a single pill once daily. Still, some patients continue to struggle with taking the once-a-day pill for various reasons, such as forgetting to take it, running out of the medication and not refilling it on time, or traveling without their medication. However, many struggle simply because their medication is a difficult daily reminder of their diagnosis.

At the STAR clinic

January 25, 2023, was a special day for me at STAR. For the first time, I had the opportunity to administer a new injection named Cabenuva to two of my patients. Cabenuva can replace daily pills for HIV treatment. It is given monthly or even every other month. Seeing the joy on my patients’ faces at their realization that they are no longer tied to their pills every day was a moment I will forever remember.

“Are you sure this is it? Can I stop taking my pills from today?” they asked in disbelief.

“You are right. You can stop taking your pills now,” was my answer.

“This seems so unreal, doctor. I never imagined this day would come. This is a new beginning for me.”

My co-residents, who are my support system at STAR

Those words resonated in my mind. Even though I have been staying on top of all developments in treating this disease, I also felt some disbelief that this incredible treatment now exists. It felt like a dream come true to be at the forefront of patient care and take this next step in making patients’ lives easier. Seeing firsthand the outcome and impact of the years of dedication and hard work of so many physicians, researchers, and other healthcare professionals trying to improve HIV treatment was certainly a professional high for me. It was also a reminder to continue to focus on patient-centric care and advocate for improving my patients’ lives. I am extremely grateful to have these moments in residency, and I look forward to having many more such moments throughout my medical career.