Decision to start treatment and possible side effects

[ShadesOfGrey80]

Ok, so I know everyone has their opinion about when to start treatment but I would like to hear you guys out. I was diagnosed positive Dec '13. Now after my 2nd set of blood work without meds I'm currently sitting at CD4 488/30% VL 1800.

I'm living in Asia at the moment and although the HIV program here is almost fully subsidized (only have to pay about USD15 for each visit and USD5 for 3 months worth of drugs). However, on the down side the doctors are not very attentive and you have to see a different one (out of the 3 they have) every other time. However, we do each have a designated nurse who handles our case.

Now the doc has asked me to start meds, but I have my doubts because he was rushing to go on lunch break. I'm wondering if I should go on it now or not. Also, he has prescribed me Kivexa + Efavirenz. Can anyone share with your experience w these meds?

[mecch]

I thought the key factor you were weighing was starting a new job. And wanting to wait until you were settled in that a few months before starting HAART.
Also doesn't seem like you are settled in one place. You seemed to be wanting to go back to Canada but that would be difficult. On the other hand, you don't seem fully committed to your present city, country, even though its been years there?
I mention this because, imo, if you are not in a crisis situation about starting, it doesn't sound like you are ready yet and should start in a solid place. Its only been a few months since your diagnosis.
If you felt solid in your job and more confident in your place and the care there, then start.

[ShadesOfGrey80]

Hey Meech,

Thanks for pointing out some key points I have outlined before. After my initial shock and desire to escape Asia due to my diagnosis, I have come to terms with this condition and I am no longer freaking out and feeling a strong urge to move back to Canada as I  would like to invest my younger and healthier years on my career to ensure I achieve my career goals and a comfortable retirement. There are opportunities for me in Asia that are harder to come by in Canada.

I feel good and excited having accepted my new job and I'm quite committed to staying in Asia the next 2 years. So in terms of mental state I am feeling more stable now.

I also want to start treatment because I would feel less scared of passing the virus to someone else. Now I'm trying to decide when to start so I have less stress. Starting now gives me some buffer time before starting work full force as I have about 2 weeks time before I start my new job and can buffer it out.

[eric48]

With this low VL and good cd4 you could safely differ meds
Cheers
Mobile.eric

[eric48]

Also, he has prescribed me Kivexa + Efavirenz. Can anyone share with your experience w these meds?

I'm on K & V ...

See
tinyurl.com/HIVPharmaCure

or

http://forums.poz.com/index.php?topic=33062.0

Have you had the HLA B*5701 test already ? This is a must do before initiating K

If I had your numbers, I'd check the virus closely but no go on meds
If I had a job opportunity in Asia, I'd stay there

Meds or no meds, you have to use condoms since you do not want other STDs, this is good enough to protect others

Hope this helps

Eric

[mecch]

Hey Meech,

Thanks for pointing out some key points I have outlined before. After my initial shock and desire to escape Asia due to my diagnosis, I have come to terms with this condition and I am no longer freaking out and feeling a strong urge to move back to Canada as I  would like to invest my younger and healthier years on my career to ensure I achieve my career goals and a comfortable retirement. There are opportunities for me in Asia that are harder to come by in Canada.

I feel good and excited having accepted my new job and I'm quite committed to staying in Asia the next 2 years. So in terms of mental state I am feeling more stable now.

I also want to start treatment because I would feel less scared of passing the virus to someone else. Now I'm trying to decide when to start so I have less stress. Starting now gives me some buffer time before starting work full force as I have about 2 weeks time before I start my new job and can buffer it out.

Ah Ok. That sounds reasonable. So get those meds, start, and get on with living

[eric48]

I'm wondering if I should go on it now or not.

For someone with high(er) CD4 AND lower VL, the benefits of lowering the VL (thanks to meds) are not that obvious from a patient's perspective

Your VL is low most likely because your body is generating immune defense against the virus.

Many docs are in favor of test and treat ; yet those who have reservations are those who take into consideration a case like yours (CD4 high, VL Low)

One argument in favor of starting meds, is that you, especially you, can always stop
(reminder: if you go on meds, you have to be adherent, this is not aspirin)

Hope this helps

Eric

[mecch]

Eric, this whole business of starting and stopping, I just haven't heard of it all that much in recent years. And maybe only very temporary due to extenuating life circumstances that are not good.

And ERIC you personally are considering a "meds vacation" (after how many years pos and with what medical recommendation??)  so you personally seem to be all over the map. 

CD4 488 isn't all that "high" - just in the safe zone, and the OP has good access to meds so I think if the decision of starting now is taken -- one should assume that its going to be for the long term, with adjustments, changes if and when necessary.  Not start "and you can always stop".  WTF

[eric48]

ShadesOfGrey,

Do not forget to read the manufacturer's label and aidsmeds page on Kivexa.

Based on the paper linked below and the fact that a HLA B*5701 test is lengthy (1 month) and costly (subsidized or not a test as a cost...), I have always recommended poster located in Asia, considering Kivexa, that they should see the HLA B*5701 test results with their own eyes.

http://tinyurl.com/kzd74a4

Local 'habits' will sometimes override the US guidelines and with good reasons sometimes
But, if you are from Canada and have this fairly low VL the odds that you are HLA B*5701 positive, hence not eligible for Kivexa, are much higher than in the local population.

You definitively want to double check this

'Asia' is large and quality of care / attention to Side effects may vary upon actual location

My 2 cts

Eric

[ShadesOfGrey80]

Hi Eric & Meech,

Thank you guys for the information! :-)