The AIDS Epidemic in San Francisco: The Response of Community Physicians, 1981-1984, Vol. I

Drug Therapy

Expanded Access to Experimental AIDS Drugs

Hughes

Well, explain expanded-access AZT.

Campbell

Every one of these antiretroviral drugs starting in 1986 or '87 first came out under expanded access. One couldn't just write prescriptions; we had to send away for the drug and have it delivered to a specific pharmacy or the office. Then the patient picked it up. But we had to fill out a lot of forms.

Hughes

The patient had to fit strict criteria in order to have access to the drug?

Campbell

Yes. You had to fill out these forms saying this and that, and there were some people that didn't exactly fit those criteria.

Hughes

So that's when you fudged.

Campbell

I did have to fudge some, yes.

Current Therapy

Campbell

With the HIV seropositive patient, several things are done to evaluate the patient: the viral load, T cells, and a history to find out if anything has happened that could be referable to HIV. There are specific recommendations about the start of antiretroviral therapy based on T cells and the viral load, and previous use of antiretroviral agents. It's become much more simplified.

All of that, of course, is tempered by the patient's particular desires. There are some that would still prefer not to be on any antiretroviral drugs; and some will want to take four of them at once, or the more the better. I know somebody now who's been on AZT for five years and only AZT, who has a

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rather intermediately high to high viral load, and who does not want to be on combination therapy or any other regimen.

Hughes

What is your approach?

Campbell

I just explained to him the reasons for the current recommendation of combination therapy. He listened and replied, "Well, no, I still don't want to take anything other than AZT, because I'm feeling fine, and AZT seems to be working, and I don't want to try anything else at this point."

Hughes

You present the information and then it's up to the patient?

Campbell

Yes. I don't feel I can force a patient to take any drug. I can only educate and recommend.

Alternative Therapies

Hughes

What is your attitude towards alternative therapies?

Campbell

Unless they seem quite harmful, I say, "That's okay for you to do." I try not to comment a lot about it, because I don't know a whole lot about it, for one thing, and many of them place a lot of faith in alternative therapy. I think that if they really find them empowering that they should be encouraged to do them, unless it seems that they're taking things in toxic amounts. I did have one patient who had unexplained diarrhea and was taking about thirteen or fourteen different herbal medicines a day that I thought really needed to stop all of them because it could be causing the diarrhea problem.

Hughes

And you said that?

Campbell

Yes, and he agreed to do it.

Hughes

What about cases in which people are using alternative therapy and are not taking orthodox therapy? Is that again their decision?

Campbell

Yes. I think my role is that of an educator, and I can explain to them exactly what has been found: if you do take triple [drug] therapy the viral load goes very low, and we have certain studies that would suggest that people with very low viral loads will do much better. If they're not convinced of that, I can't say, "You'd better take these anyway." The pendulum goes back and forth regarding the efficacy of

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antiretrovirals. Two or three years ago, people were generally against antiretrovirals because of the Concorde study, and now they're pro-antiviral therapy because of protease inhibitors and various combinations that seem to be reducing viral load. So the pendulum's probably going to swing someplace else in a couple of years, depending on what the technology is.

About this text
Courtesy of Regional Oral History Office, University of California, Berkeley
http://content.cdlib.org/view?docId=kt6580067h&brand=oac4
Title: The AIDS Epidemic in San Francisco: The Response of Community Physicians, 1981-1984, Vol. I
By:  Sally Smith Hughes
Date: 1996
Contributing Institution: Regional Oral History Office, University of California, Berkeley
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