on ATRIPLA looking for expert on numbers to help with treatment

[webontheweb]

I am looking for someone who is medically knowledgeable about Atripla and HIV.  Have been on it now for 2 years.  Just got test results for 90 day check up and not much change again.
I started at CD4 of 134, results from this test 235.  I have the prinout of the complete blood workup and would like to talk with someone well versed in treatment.  I tried mentor site, but did not see anyone that I thought could help.  I am trying to contact one person, but am making a general plea to this room.
Could anyone advanced in numbers interpretation please contact me privately to help me out?
Cheers!

[Inchlingblue]

In case you cannot find anyone thebody.com has a Q&A forum called Understanding Your Labs. There are questions already on there that have been answered by a reputable doctor that you can read through. You can also do searches on a specific subject matter and you can also ask your own question, they usually respond within a few days.

LINK

http://www.thebody.com/Forums/AIDS/Labs/index.html

Did some of the results come back out of range? As a general rule of thumb: if something is just barely out of range, it's usually not that big a deal. Also, just one reading is usually not enough to go by. The things to concentrate on are readings that are considerably out of normal range and more than just once.

[newt]

To be honest, at this point, your viral load is the only important result, and then perhaps CD4.

But post the numbers and I will comment.

- matt

[webontheweb]

Okay here goes.  started out 2 years ago at 134 with  viral load of 77,000.
Then - 198, 177, 202,  198,  225,  247,  235
VL went to UND in first month and has stayed there.
White blood cel count hovers at 2.9 to 3.2
They had me on Bactrim for a long time and only took me off of it in January. 
I am on Atripla only.  I am wondering if I need to supplement my therapy to help boost the CD4?
I have been fighting fatigue and also "brain fog"- although I see a neurologist in two weeks just to make sure there is nothing else wrong there.
I just want to get my cd4 higher if I can.  I do not smoke, drink very very occasionally- like one a week- eat a very good diet.  Am back on vitamins and supplements
So what else do you want to know?  We can take it private, I am more comfortable sharing other things in that manner.

[Inchlingblue]

In the past, attempts at boosting CD4 counts have not panned out (such as IL2), but a recent study that did an intensification of treatment by adding one more drug, in this case Isentress, ended up having the effect of boosting CD4s. This was just one study and needs to be looked at more carefully but it looks like adding one more medication to an already existing regimen can maybe boost CD4s

Boosting CD4 Counts

Question:

Some patients can get their viral load undetectable with a regimen, but their CD4 count does not budge. It's been a frustrating issue for both people living with HIV and their health care providers. Is Isentress one of the few drugs that might work?

Answer:

It may be. I wouldn't have said so until this meeting. When I saw the intensification study, it was interesting that the CD4 count increased, even though there was no obvious virologic benefit. I think it's worth pursuing this in a larger intensification study for people who are having poor CD4 count responses.

There's currently an ongoing ACTG study using Selzentry for that purpose. We'll see what that shows.

It's interesting that despite the fact that Sustiva always seems to do the best virologically, it doesn't do the best from a CD4 standpoint. Almost everything that you compare it with has a better CD4 response. This has been shown for protease inhibitors, for Isentress, for Selzentry.

It's not a huge difference, and probably not a meaningful enough difference to make a change in what regimen you would decide to start with. But it could have relevance for those people who have poor CD4 responses on antiretroviral therapy. There may be something to this idea of intensification, at least with certain drugs.

I would point out, though, that this is only a problem for people who wait until their CD4 is very low to start therapy. If we would diagnose and treat people at much higher CD4 counts, we wouldn't have to deal with this issue.

By waiting until your CD4 is very low, you run the risk that you've exhausted your immune system's ability to recover, and that -- with the possible exception of these intensification ideas -- there may simply be not much that you can do about it. The answer probably isn't more drugs; it's earlier treatment.


LINK:

http://www.thebody.com/content/confs/ias2009/art53122.html#boosting

[newt]

Your white blood count is low but then not surprising given your CD4 being lowish.

but overall a good and expected result.  After 2 years, starting at a CD4 count around 150, you would expect it to be around 250 now. After 5 years it might touch 300. Hard to say tho, what happens on average is not predictive for you. Might well be higher than 300 or just the same as now. (see graph).

A switch to a non-NNRTI based combo may give a modestly better CD4 rise, but also perhaps increase your cardiovascular risk and your pill count. Choices, choices...

There's nowt much wrong with your numbers at this point really.

The ACTG study using Selzentry is worth following for the results.

- matt

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[webontheweb]

Thank you for your information.  I am going to hav another doctor look at all the blood work results just to make sure that there is not anything wrong.  I do not get colds easily which is good.  Have not really been seriously ill since finding out HIV+ so I do count my blessings.'
If I come accross anything interesting, I will update you.
Cheers