Age or Atripla? Symptoms or nothing- Why doesn't my cd4 count change?

[webontheweb]

I just had my quarterly HIV Dr. Appointment.  I am 9 months into treatment.  Age 46- when diagnosed last August my viral load was 77,000 and CD4 was 134.  My partner was diagnosed due to hospitalization with PCP and a CD4 of 10, VL 440,000.  Neither one of us knew we were poz, or even suspected.  Ever since treatment started my viral load went down to 500 and then three times has been below 45.  My Cd4 count went 134-204-174-178.
I don't smoke, or drink more than two drinks a week.  I do not get sick.  Do not even get average colds usually.  I have had an incredibly stressful time since February when my mother died of pancreatic cancer.  She was hospitalized on Feb 6, diagnosed 3 days later and died February 26.
My partner and I almost told her and my step dad over Christmas and I am so damn glad now that I did not tell her as she would have been so worried.  Thank god I was already on Prozac as it really helped me get through this difficult time.  ANYWAY- now to my question(s).
1.  Is it difficult to get off prozac?  I think I am ready to get out from under that umbrella.

2.  Why aren't my CD4 counts higher?

3.  Any suggestions for general malaise and/or exhaustion?  I am trying to deal with the short term memory loss, but the fatigue factor is really bringing me down.

4.  Also, it seems that since treatment started I have to be careful and not stand up too soon, or go from a crouch to full standing position or I feel like I am going to keel over.  My stronger feeling than a "head rush".  It is scary.

5.  Should I ask my doctor for Ed medication to help out in the bedroom?  I just don't "feel like it" as often as I used to even though the sex is still good.  It is not an aversion to sex, just a lack of drive.

I have an appointment coming up with the internal medicine Doctor who is great.  I like my HIV Dr. a lot also, but she is in a clinic and there is not always time to get to all these things. 
Any advice-- oh great and wise ones?
Cheers,
"Sometimes hanging by a thread, but determined to carry on"

[aztecan]

Howdy Web,

Welcome to the forums, glad you have joined in, though sad for the reason.

Wow, you've had a bit of a time of it. Please accept my condolences on the loss of your mother.

I have no first-hand knowledge of Prozac, but I believe you must taper off. I would put this question to your doc when you see him.

Regarding your CD4 counts. Well, your meds are doing what they are supposed to do - attack the virus. A viral load of 45 or less is considered undetectable so, congratulations, You have gotten to a place where many would like to be.

Now, your CD4s are a different story. The meds don't do anything to help them, that is up to your body. You started at 134, which is pretty low.

You also have been through a lot of stress lately with your mother and your partner being ill. Stress really knocks the you-know-what out of your CD4s, so that probably has not helped.

Just give yourself time. Some people I know have spent a long time waiting for their CD4s to climb. Just be patient. I' sure yours will too.

The malaise and feeling of exhaustion could be from any of a number of things. For one, Atripla has been known to cause this. Have you felt this way since you started meds?

Again, I would bring it up with the doctor to see what he says. There are just too many variables to be guessing and its better for the doctor to be made aware of how you are feeling.

As far as the lightheadedness goes, I had that problem for a while. Still do sometimes. My problem was too little salt in my diet. (Go figure, most people have to cut salt intake.)

This is something the doctor should know as well. He could check your blood pressure, for example. Low blood pressure, which was my problem, could be the reason you get lightheaded. It also could contribute to the fatigue. At least it did for me.

As far as the ED thing goes, honey, you're on your own!   I have found I am just not always as interested in sex as I once was, especially since I passed 50. But, there are many variables here and, if memory serves, some ED drugs don't mix well with some HIV meds.

I would make a list of these and any other questions to take with me to the doctor's visit. I always forget something otherwise because we get sidetracked on some other issue.

I know I wasn't much help today, but I am glad you've joined in and look forward to hearing more from you.

Let me know what you find out from the doctor.

HUGS,

Mark

[webontheweb]

 

Hi Marm
Thanks for the quick reply.  My regualr doc started me on fluoxetine-prozac when I told him about being on xanax and it was not really working.  I needed it at the time and it has helped me.  I just think that I am at the point where I can handle things without assistance frm the pharmaceutical community.
What is funny about the terrible year that I have been through, is the fact that when my mother was sick and then died more than one person at work said outwardly I semmed to be dealing well with the stress.  Ha ha-  If they only knew! 
It has been 12 to 13 months of incredible stress in the house-  My partner- Husband really- we got married in Toronto in 2006-  Get along very well.
I do make lists when I go to the doctor.  My reg doctor gives all the time you need with him.  He is fantastic!
I do not get to see him for another three weeks.  My 12 month panels will be done in late august.
I ma not as down as my first post would make it appear.  I really do look forward to each and every day.  IT has just been a very painful adjustment this year trying to stay positive and focused on the now. 
Cheers, guys and gals

[webontheweb]

I did not just call you Marm!!!!!  sorry!!!!!  MARK!

[YaKaMein]

Hey Web and welcome,

You've certainly been thru a lot recently and I hope things continue to get better.

Listen to Mark and others [they're much wiser than I about many things]; he's proffered some good remarks that I ditto.

My CD4s are slooow too ... just don't make 'em very fast I guess ... hopefully, we will over time.

You might bring up discontinuing the Prosac with your doctor in case you need to decrease dosage over a brief time.

Anit-depressants are notorious for affecting sexual function or mood. There may be many causes for some of your concerns.

I hope things improve fast for you.

-YaKa

[aztecan]

I did not just call you Marm!!!!!  sorry!!!!!  MARK!

Hey, some people call me Mother Mark, although how I got that name, I'll never tell!  

Speaking of marriage, two couples who were part of the AIDSMeds Gathering in Montreal two years ago (can it really have been that long?) got married while we were there.

What's more, I got to dance with a very sexy young man! Made my day, I'll tell ya.

HUGS,

Mark

[woodshere]

I found out I was poz in my early 40's and started treatment immediately since my cd4 was 179.  My VL dropped to undetectable in 3-4 mths, but with the cd4 it was a very slow rise to 191, 212, 237, 273.....extremely frustrating, especially when some people on here have huge jumps.  Finally after  about 18 months of meds I had a huge jump into the 500's.  Everyone's reaction to meds is different, but as Mark said they are doing the trick, just give it time.

Welcome and best to you,
Woods

[Morton Salt]

 

[BT65]

Web, as far as the Prozac is concerned, I believe you do need to be tapered off of it.  I think that's the case with any antidepressant. 

Mark's right on about your CD4 count/viral load.  Just give it some time.

About the ED, sorry, you're on your own there.  I don't have that equipment to worry about.

[Miss Philicia]

Prozac is an SSRI and can have the side effect of sexual dysfunction, reduced libido and impotence.  For this reason I didn't last on this wretched pill for longer than 2-3 months.  As with any SSRI you need to taper off of it slowly to avoid withdrawal issues, and this should naturally be done under the supervision and advice of your prescribing psychiatrist.

As far as your cd4 counts, as stated by others when you begin with a low count like you have done it can take years to see decent increases.  I began around the same numbers as you did, 15 years ago, and for the first 4 years or so I got consistently up to around 250-300.  Then the next 4 years I stayed consistently in the 400's.  For the past 2 years, however, after going on more novel new HIV meds I've maintained cd4's of 1,000 or more   Bottom line is that it's a very long journey to build up your immune system, but the goal for now should be suppression of your viral load, and you're not there consistently yet after 9 months from what you've stated (unless the three instances of <45 have been your last 3 lab results, then that's OK.)

I think I'd attempt tapering off the Prozac before going down the road of ED meds, etc. certainly if you feel mentally ready to do so.  It's generally a good idea to maintain one-on-one therapy sessions while going off of a psychiatric med -- are you already doing therapy sessions?