First Lab Results - I Am Scared!

[poz+pos]

I am a 24 year old male...in great shape, exercise regularly, got all my blood work done and all my vitamin levels are great, organs functioning great including kidneys and liver. Relatively recently was diagnosed with HIV. Spoke with my doctor and we both did not want to make any assumptions but thought my cd4 counts and viral load would be at levels where I wouldn't need meds. He took them anyway of course just to see what they were.   

CD4 - 182
Viral Load - 104,000

I AM TERRIFIED. Should I be? I am starting atripla Friday. Why would these numbers be like this? I feel great. No recent illnesses. Was infected in the last year.

Should I see an infectious disease specialist on top of my general doctor (who has many hiv positive patients and is well versed in the literature)?

What can I do other than the medications?

Should I get a flu shot?

Should I start taking preemptive medications (antibiotics) since my counts are so low?

Any help would be greatly appreciated...thank you.   

[GoForIt]

I wouldn't be TERRIFIED at your results but it would cause great concern.

Your CD4 can vary 100 points at any given time in the day depending on if your tired, or just recently ate, or other factors.... so the number 182 isn't a solid number...its just what they pulled at that time in that tube.

BUT, 182 is low enough to be considered AIDS  (I think under 200 is AIDS or so?)
SO, any infectious disease specialist would start you on meds immediately to bring your CD4 up and that Viral load down.  The meds will be able to take you out of being "TERRIFIED". 

I personally would get a specialist if I were you regardless of your numbers.

[buginme2]

If your doctor is experienced with treating people with HIV and your comfortable with him/her then there is no need to switch.  Not all doctors that treat HIV patients are infectious disease specialist nor should they be.  My doctor is an HIV specialist but not an ID doctor. 

Your numbers are not great but they will improve with treatment. 

What can you do other than medications? Well, not a whole lot.  Clean living can't hurt but the majority of this will improve if and only if your adherent to your meds.  That's pretty much the bottom line.

[mecch]

More precise information, please.
When exactly were you diagnosed?
Prior to the diagnosis, were there previous HIV negative tests, and when?
In other words, any good estimate how long HIV+? 

If you are in seroconversion, your cd4s could have taken an especially hard hit but could improve, maybe. But even then, its low.   If you have been HIV+ awhile, sorry, you just got the bad luck to have an immune system that can't fight HIV very well. Don't be terrified because HAART works very well.  Just be sure you find excellent doc and stick to all the treatment recommendations. Soon enough, you'll be on your way to a stronger immune system.

You can't assume anything about how your immune system is, just because you "feel" well. One of top 5 rules of living well with HIV.

SO even if you got the bad luck of not being an HIV fighter, at least you got the good luck that so far, you haven't felt sick.  Win some lose some.

Your doc should answer this question about the flu shot and certainly about the antibiotics. If he doesn't give you a rational why you are not on antibiotics, get a new doc.

[pittman]

Did you find out your CD4% yet?  That is a somewhat better indicator than the CD4 alone.   CD4 numbers jump around a lot.

In any case, there are those who started meds at MUCH lower CD4 numbers and are now doing just fine.

As to your other questions, here is what I did/experienced:

• My numbers were similar, just slightly higher when I started meds. I was doing much better within 3 months as far as test results.
• I never felt sick. That will simply vary by individual
• I saw an infectious disease specialist, and eventually made him my PCP. The clinic offered more comprehensive services than my old doctor, who was also very educated on HIV. For me it was the convenience of having the same group do end to end treatment.
• The doctor did not proscribe antibiotics. He did however give me several immunizations for: pneumonia, hepatitis booster, tetanus booster, and I think one other.  After my numbers improved above 340-350, he then regave some of the immunizations as my body would better be able to use them with a more intact immune system. 
• I had a few days of slight dizziness for about an hour after I took my Atripla before bed. After that first 2 weeks, I could decern no side effects at all
• I read far too much from old studies and news that was out of date and gave me false impressions on what I was likely to deal with. The reality has been so much better.

You are at a very difficult point as far as the number of things you now have to deal with, but it will calm down. 

You are actualy lucky in that you are starting treatment at a point when the meds are very effective and will keep the HIV in check.

[aaware72]

Hi it ia a scary situation as I have been there myself.  I last neg test was 5/12 and I tested poz on 01/13.  They figured I converted first of August.  My first CD
was in 02/13 it was 230 and my VR 53,000.  I'm on Stirbild have been UD since 5/13 and my CDS is know in the 400's. 

[xinyuan]

A CD4 <200 with confirmed HIV meets current US criteria for AIDS.  Should you be terrified? No. But a healthy amount of fear to kick you in the right direction couldn't hurt.

Many do not develop or remember symptoms of seroconversion. Be thankful that you didn't find out through an opportunistic infection (OI). Those are nasty and could have left you debilitated for up to months.

Based on those numbers, any competent and up-to-date doctor will tell you to start antiretrovirals ASAP. If your doctor is well versed in the literature, s/he should be aware of newer meds and studies, be able to tailor your therapy and response, know how to monitor for resistance, and watch out for treatment side effects. If s/he can't do that, do find an infectious disease expert who specializes in HIV and whom you can trust. It's going to be a long relationship.

For CD4's that low, you are at greater risk for certain OI's (mainly, the dreaded pneumocystis pneumonia). There are preventive (prophylactic) antibiotics that your doctor should start to prevent these OI's, but these can be discontinued once the CD4 climbs. I would encourage you to talk to him/her about these. Absolutely get the flu shot.

As far as other things to do, I'm in the same boat with you on that one. Trying to eat right, to stay fit, to keep a medication schedule (100% so far), to stay sane (working with a counselor on depression and anxiety).