Developing resistance to meds as an UD

[mustrlon]

If you have been undetectable for almost 1.5 years, can you catch a new resistant HIV virus (from positive partner(s) with detectable viral loads- and I don't know if they are detectable or not) and can this cause you to change your treatment? I know this has been discussed before but more in case of UD - UD encounters. If you had occasional unprotected sex (but not often) with other positives, sure there is Hep C and other STDs, but what are the risks of a new HIV infection and having to change the treatment you're on? I thought that the meds were acting as PEP and PREP when you had negative viral loads.

And can CD4 percentages fluctuate just like CD4 absolute values when you've been on treatment for nearly 2 years? Started at 10% (151 absolute count) then 16%(299), then 20%(654), then 14%(410), then repeat test in 1 month and 21%(620) then 27.3%(590), then down to 18%(429) (tests are every 3 months and undetectable all this time but the last viral load test result is not known yet) and took medications every single day- not missing a dose- started with Truvada Kaletra then switched to Truvada Stocrin 1 year into the treatment.

There is either something wrong with the way my hospital lab is reading test results or I developed resistance somehow.. My doc says she sees fluctuations both in absolute counts and percentages of other patients. I've been using Wellbutrin (through a psychiatrist) for 1.5 months but that doesn't affect the blood levels of Atripla either. I am a bit worried as there aren't too many options out there when I lose the Truvada part. I have no symptoms-healthy and no flu or cold for quite some time, and just puzzled how CD4 can go down so quickly in 1 or 2 months- which would mean this could kill me in a few months if off medication, although I know the viral load can reach 100s of 1000s quickly when you develop resistance.

[vertigo]

So let me get this straight.  You have been consistently undetectable for 1.5 years, got one wonky lab result with a lowered CD4 count, your doctor is not worried, but you're self-diagnosing viral resistance and treatment failure?

I'm going to go out on a limb and say that your correct diagnosis is anxiety.

As far as I know, the HIV "superinfection" stories are mostly scare tactics to make UD pozzies feel guilty about having condomless sex with each other.  Not a real thing.

And some doctors actually now advocate not doing CD4 testing AT ALL on people with sustained successful treatment, in part to avoid freakouts when the numbers fluctuate.

If your doctor is not worried than I see no reason for you to be.  Try to relax 

[Raf]

As far as I know, if your viral load gets higher over many lab tests, that's when you MAY be developing a resistance to your meds.

Sometimes CD4 counts may fluctuate, depending when the test was done.

[mustrlon]

So let me get this straight.  You have been consistently undetectable for 1.5 years, got one wonky lab result with a lowered CD4 count, your doctor is not worried, but you're self-diagnosing viral resistance and treatment failure?

I'm going to go out on a limb and say that your correct diagnosis is anxiety.

As far as I know, the HIV "superinfection" stories are mostly scare tactics to make UD pozzies feel guilty about having condomless sex with each other.  Not a real thing.

And some doctors actually now advocate not doing CD4 testing AT ALL on people with sustained successful treatment, in part to avoid freakouts when the numbers fluctuate.

If your doctor is not worried than I see no reason for you to be.  Try to relax 

CD4 obviously is not the only indicator of immune system and the values can fluctuate, I just wasn't sure about the percentages. It is the 2nd time the % is down- first time it happened 9 months ago and looks weird the way it is going up and down (7% up in 1 month, 9% down). I can worry a bit by nature : ) That's why started taking the antidepressant / anxiety pills for the negative effects of Atripla. I am looking into Stribild- will need to find out if any better, so that perhaps I can slowly quit Wellbutrin too. Not keen on taking antidepressants.

[pittman]

The direct answer is yes, both CD4 and your % can fluctuate. However, the % is much more stable and thus usually used in conjunction with CD4.

Now the real answer is that it does not matter once you are consistently out of the range where you would be prone to opportunistic infections.  The number you want to always test for is your viral load to make sure it is suppressed.

Outside of that, your general blood work including those to monitor liver and kidney functions as well as your triglyceride and cholesterol levels should be done.

[bocker3]

You know what else can impact your CD4s??  STRESS!!

Don't go looking for problems - you have a doctor interpreting your lab results and, I assume, assessing trends in them.  If you are finding things to worry about in places where others are not worrying, it may be time to stop looking so hard.  I know the internet is a great place to learn things -- it is also a terrible curse because people see (and often focus on) the worst case scenarios when it comes to their health.

All lab results can fluctuate - some more than others and in some people more than in others.  Add in the occasional issue with specimen handling and/or laboratory error and you get even more potential fluctuations.  This is why the labs are repeated at set intervals.  Rarely is a single value of much diagnostic significance -- one may lead to a repeat or additional tests, but rarely does a single value, in routine tests, result in anything definitive.

As pittman pointed out - you are now at a point where your UD VL is the key to how your treatment is going.  BTW - you WILL likely have a VL Blip at some point -- try not to let it set you on a path of doom and gloom.

Mike

[vertigo]

If you're having anxiety/depression issues, then Atripla may not be the best choice.  The Sustiva component of that drug is known to contribute to those issues.  It sounds like you're already well aware of that.  I think checking out Stribild is a great idea.  Complera is also another good option, also just one pill a day.  Good luck.