The flaws of ‘El Cantante’

“El Cantante,” Picturehouse films, directed by Leon Ichaso, premiered in the U.S. Aug. 3.

The premise: Hector Lavoe (played by Marc Anthony) is a legendary Puerto Rican salsa singer in the 1970s and ‘80s whose unhealthful lifestyle includes multiple sexual partners, cigarettes, excessive alcohol, cocaine and intravenous heroin.

He becomes more and more erratic and unreliable, and this downhill spiral destroys his singing career. After landing in Creedmoor Psychiatric Center in Queens, N.Y., he is discharged on psychotropic medications.

But Lavoe doesn’t go to drug rehab, and he is not compliant with his antidepressant and anti-anxiety medication regimen. In 1985, he is diagnosed with HIV -- a time when AZT and other AIDS drugs were not yet available -- but his physician tells him he may not develop AIDS for several years or at all. Ultimately, Lavoe develops AIDS and dies of its complications in 1993.

The medical questions: How common was HIV among intravenous-drug abusers in the 1980s? Were there any AIDS drugs available in 1985? How frequently do untreated HIV cases progress to full-blown AIDS (with immunodeficiency and opportunistic infections)? What were the most frequent opportunistic infections affecting AIDS patients in the 1980s and ‘90s?

The reality: Multiple studies in the epidemiological literature found HIV present in the blood of 15% to 30% of intravenous-drug users, with the highest percentage among those who frequented shooting galleries where needles were shared by multiple users.

AZT, the first anti-viral drug used for AIDS, was still being studied in humans in 1985, when Lavoe was diagnosed with HIV, and wasn’t approved for widespread use until the late 1980s.

Before drug treatment became readily available, 20% to 30% of people infected with HIV developed AIDS in three to five years, the federal Centers for Disease Control and Prevention has reported.

So “El Cantante” is historically inaccurate when Lavoe’s physician reassures him that it might take several years for symptoms to develop. In reality, physicians of the time were petrified of HIV progressing to AIDS and had far worse expectations.

The most frequent opportunistic infections early in the AIDS epidemic were Pneumocystis carinii pneumonia, oral candida, cytomegalovirus, toxoplasmosis, and mycobacteria (avium and tuberculosis). According to David Maldonado, Lavoe’s longtime road manager and a producer of the film, Lavoe died of Pneumocystis carinii pneumonia.

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Dr. Marc Siegel is an internist and an associate professor of medicine at New York University’s School of Medicine. He can be reached at marc@doctorsiegel.com.