Researchers are convinced that bone loss

Researchers are convinced that bone loss, perhaps more clearly than the other conditions, is a direct side effect of the medications, while the brain issues are more likely to be related to HIV itself. Further puzzling to researchers is why some patients don’t experience any problems at all, even after living with HIV for decades. Dr. Justin McArthur at Johns Hopkins says genetic factors may be at play. That might explain the case of two Brooklyn-based neuroscientists I met recently, both of whom tested positive 22 years ago, a few months after they started dating. They asked me to call them by their middle names. Joseph has had almost no bumps in the road. But Donald’s path through HIV has been extremely tumultuous. Though his body responded well to the drugs, over the years he has nonetheless developed AIDS-related pneumonias, skin cancer, seizures, heart problems, and systemic infections ordinary patients might have rebuffed. He managed to keep a high-powered career in research and even returned to school to study law recently. But with weeks left before getting his law degree this summer, he developed a case of HIV encephalitis that left him in a state of disorientation. During a recent visit to their home, he was unsteady on his feet and sometimes unable to answer simple questions.

“Do you know what today’s date is?” his husband asked.

Donald looked at him blankly, then gave a small, nervous laugh.

Joseph tried another tack. “What year is it?”

“That, I got this morning,” Donald answered quickly. Maybe so, but now it wasn’t so easy. He glanced at the corners of the ceiling. It finally came to him. “Two thousand and nine,” he said. “Because I was supposed to graduate this year.”

It was hard to imagine, but just weeks earlier this man was about to earn a law degree. I asked him, “Have you lost your legal education? Is that still there?”

He smiled. “Get back to me on that one,” he said. Then tears brimmed his eyes, and he let on for the first time that, like the character in Flowers for Algernon, he was a conscious witness to his own decline. “I’m fearful that I’m going to be a janitor someplace,” he said.

“He had his Ph.D. at 25,” Joseph told me. “His thesis work—it’s in nearly every new neuroscience textbook in the country.”

“True,” Donald agreed. “Now what am I doing?”