your opinion for someone that just started with living

[SFRJ]

Hi guys,

I find out that I am positive in Feb 2014 and my CD4 at that moment was only 14. Since then I had PCP and Lymphoma (both are eliminated now) and my CD4 three months of Kivexa and Strocin therapy was 140, while VL was about 150. However, in August I did a new testing and CD4 fall to 105, while VL is 178 000.

I will see my doctor as soon as he is back from holiday, but since I am new and in panic, what do you think about the situation ? Thanks for answers (in advance)

[Miss Philicia]

Your viral load, since you are on treatment, should not be going up to 178,000 as this clearly indicates one of two things 1) testing error -- entirely possible or 2) treatment failure.

When does your doctor return from his holiday? Is someone else covering for him in his absence? Standard protocol would indicate immediate retesting to rule out an error, and if treatment failure is occurring obviously you will have to change to another regimen immediately. Additionally, because you began your diagnosis with very low cd4 count and had opportunistic infections, a significant rise in viral load such as is exhibited will possibly quickly cause your cd4 count to decline.

[SFRJ]

Thanks for quick answer. I will see my doc on 10 Sept, hope that this is not too late. Everything sounds quite strange, because I feel really good and I am taking my medicine every evening in the same time without problems...

[Miss Philicia]

You did not answer my question fully -- is there someone in his office working for him while he is on vacation? I would not wait two weeks to confer on this subject -- as they will have to run more blood tests which will add another week to the process ad that's assuming you went today to see someone. Personally I would insist on seeing someone immediately to do more blood tests.

[SFRJ]

Thank you again. Quite problematic in my country, not really anyone that is replacing him.I will do my best

[eric48]

This matter should be handled with out delay

Retest is not expensive and quick (48h.)

Test error of that amplitude should be rare

The other possibility is that treatment has failed (virologic failure)

Certainly not the end of the world...but requires Hiv specialist to solve that

Keeping taking meds on a failed combo will only add in more resistance

get expert assistance ASAP

[eric48]

If you think a retest is needed, try to go to the lab, discuss the case and see if if you can get get VL test done without prescription

In many places this is doable

This will save you time

[absopozilutely]

This matter should be handled with out delay

Retest is not expensive and quick (48h.)

Test error of that amplitude should be rare

The other possibility is that treatment has failed (virologic failure)

Certainly not the end of the world...but requires Hiv specialist to solve that

Keeping taking meds on a failed combo will only add in more resistance

get expert assistance ASAP

If he's already resistant I highly doubt that continuing meds is going to cause "more" resistance. Either he's resistant or not, if it was a lab error him stopping meds would be horrific, damaging advice. Be careful in what you advise people.

[SFRJ]

Thanks guys, I will talk to doc without delay, that is the best thing I can do.

[eric48]

Certainly not the end of the world...but requires Hiv specialist to solve that

Modern second line therapy is no comparison with what used to be around in the past.

These are also combinaisons of usually very well tolerated drugs

So you can relax.   

I will talk to doc without delay

That is the spirit. Keep us posted

[SFRJ]

Just to keep you posted:

Doctor changed therapy to: Viread + Epivir + Aluvia. Just started with that. Any experiences ?

[xinyuan]

Viread = Tenofovir (NRTI) - 1 of 2 components of Truvada
Epivir = Lamivudine (NRTI) - 1 of 2 components of Kivexa (aka Epzicom)
Aluvia = Lopinavir/ritonavir (boosted PI)

Your doctor's choices make sense. The Viread is a different nuc (NRTI). And protease inhibitors (PI's) have the highest barrier to resistance. In other words, it's harder for HIV to become resistant to PI's.

I've been on a different boosted protease inhibitor (darunavir, aka Prezista). Can't say I liked the side effects. The boosting agent ritonavir is known to cause diarrhea and other stomach issues.

Make sure you get your lipids checked in a few months. PI's are known to affect cholesterol in a bad way.

[eric48]

You should be fine this time...

Now, you need to plan now for the future.

In 5, 10, 15 y. from now, HIV will not be managed as it is today

There is one thing that you can anticipate: HIV is lifelong and at some point of your future with it, your new combo will be revisited, may be by the same doctor, may be by another one...

you can foresee, that at that time, this resistance chart will still play a paramount role in decision taking. (resistance test should be done prior to the first treatment initiation, as per EU guidelines, most likely so by US guidelines)

Since you have had a viral rebound while initiating meds, your (future) doctor will need the resistance test of that very rebound. Not the resistance test done initially, but the one that can be done on your bold draw (August 28 ?  with VL: 178 000)

If you current doctor has not ordered a resistance test, it can still be done. Labs are supposed to store blood for a year and resistance test can be done on stored blood. You should insist to get such information and be carefull to keep it with you for the future
The resistance test is sometimes called Genotype 

This does not affect your current management. This is not critical for now or tomorrow at all, but...

15, 20 y. down the road, you will find very useful to have this resistance test at hand .

Again, you should be fine now with this new combo...

[absopozilutely]

You should be fine this time...

Now, you need to plan now for the future.

In 5, 10, 15 y. from now, HIV will not be managed as it is today

There is one thing that you can anticipate: HIV is lifelong and at some point of your future with it, your new combo will be revisited, may be by the same doctor, may be by another one...

you can foresee, that at that time, this resistance chart will still play a paramount role in decision taking. (resistance test should be done prior to the first treatment initiation, as per EU guidelines, most likely so by US guidelines)

Since you have had a viral rebound while initiating meds, your (future) doctor will need the resistance test of that very rebound. Not the resistance test done initially, but the one that can be done on your bold draw (August 28 ?  with VL: 178 000)

If you current doctor has not ordered a resistance test, it can still be done. Labs are supposed to store blood for a year and resistance test can be done on stored blood. You should insist to get such information and be carefull to keep it with you for the future
The resistance test is sometimes called Genotype 

This does not affect your current management. This is not critical for now or tomorrow at all, but...

15, 20 y. down the road, you will find very useful to have this resistance test at hand .

Again, you should be fine now with this new combo...

I'm just gonna bank that in 20 years we will eradicate HIV

[xinyuan]

I'm just gonna bank that in 20 years we will eradicate HIV

And the only way to make it there:
Keep taking effective cART meds.