The FIRST test results are in....thoughts?

[Poz-3/6/07]

Well, I just arrived back from my second trip to my doctor, and this time he gave me the news on how HIV is working in my system.

As you may remember from my earlier, I was infected back in November 2006 and tested positive in March 2007.

My previous doctor told me I had Epstein Barr Virus (Mono), however my new ID doctor feels it probably was acute HIV.

The results:

VL - 750,000
CD4 - 350 (13%)
AST - 62

The ID doctor has advised that I start Atripla.

I would appreciate any of your thoughts on what you see.
By the way, this is only the first round of blood tests, however my ID states at this medical clinic they manage HIV with therapy. (Atripla)

He did state is was totally my choice seeing how much of a commitment it is, however he and his team see over 160 HIV patients, so I have to believe his expertise in the area.

After reading these forums when I first found out I was positive, I have to let all of you know that you made what couldve been a frightening day...a much easier one to swallow.

Your candid advice to each other and constant support in sharing your stories has helped me continue to stay positive about being positive

Any thoughts on starting therapy with my numbers? acute HIV?

Staying positive
 

[Andy Velez]

Poz, I'm glad you have found reading these pages to be helpful to you.

As for beginning treatment, it's commonly recommended to get more than one set of numbers before making a decision to start meds. By doing that you can get a sense of a pattern. Especially when newly infected, there is often a rebounding to more favorable numbers. Postponing a decision for a few months is not going to put you into a hazardous situation.

It's very good that you have already begun developing a relationship with your doctor. A good working partnership of that kind is one of your best tools for staying well. I would also recommend getting his opinion on waiting for at least one more round of test results.

Cheers,

[Ann]

Hi Poz, welcome to the forums.

Your numbers are entirely consistent with primary hiv infection. You have two choices. One is to start the Atripla as your doctor suggests. However, your numbers will likely improve on their own and you could go for years without needing meds.

As Andy says, it is recommended that you get several results under your belt before making the decision to start meds. Taking hiv meds is a big commitment because you have to take them every time, on time (give or take an hour). They can have a big impact on your lifestyle, between the strict compliance they demand and the possible side-effects.

There have been several other newly infected people post here and some of them took the decision to wait for more results. None of them have had to go on to meds yet because their numbers did indeed improve. If you search on "starting meds" you will find some of the threads.

You DO have time to make this decision, so don't let your doctor rush you. Read through the Lessons (link in upper left-hand corner of any forum page) on starting meds and other treatment issues. Learn all you can so you can make an INFORMED decision. Feel free to come back here to ask any questions that may arise during your reading.

Remember, as you are newly infected you have time to do your homework and also to get more results so you can establish a trend. It takes more than one or two results to do this.

Hang in there!

Ann

[megasept]

[quote ...
As you may remember from my earlier, I was infected back in November 2006 and tested positive in March 2007.

My previous doctor told me I had Epstein Barr Virus (Mono), however my new ID doctor feels it probably was acute HIV...

VL - 750,000
CD4 - 350 (13%)
AST - 62

The ID doctor has advised that I start Atripla.

I would appreciate any of your thoughts on what you see.

Staying positive
 
[/quote]

Hi, though I have a hard time disagreeing with either Ann or Andy (because they are knowledgeable, rational, and awfully nice), I find it hard to believe your VL will drop from 3/4 million down to say under 50k. Yes there's a "spiking" curve at work. Your CD4s are OK, but not that far above where I would suggest therapy (300 or even 350). So I would plan on therapy and that you spend time here reading the posts that deal with this and that combo (every drug has it's critics here!). If you wait a few more weeks (for more results), it won't matter much, or at all, Andy's point. But I believe you should prepare yourself mentally for therapy. With meds, most likely you will see dramatic short term and long term results. I am not currently on therapy (for last 6 years now of nearly 17 years POZ), but will be when my VL reaches 100k and/or my CD4s drop to around 300. So, my difference with Andy and Ann here is just one of nuance---we aren't in different "camps" on this. I am glad neither Andy or Ann think everybody should be on meds no matter what. Some posters here, and their MDs, don't agree. Good luck, and keep your fine attitude.  -megasept

[fondeveau]

I think the current standard of care would indicate offering treatment to anyone with a CD4 at 350 or below.  Therefore, your doctor would be committing malpractice to advise to not offer treatment.  That said, there are reasons why there are standards of care, i.e. the best outcome for the patient. 

I had a CD4 of 285 and VL of 30k when I first say my ID specialist in October 2006.  They indicated that they would have believed me to be infected for five years, but for consistent negatives.  The alternative thesis was that I had a very strong immune system.  But, without prior baseline measurements, who knows.  My own thoughts were that the infection was recent and that perhaps I was seroconverting at my first appointment as I was suffering from very flu-like systems. 

At any rate, I've been on Atripla since mid-October 2006 and my CD4s are now 734 and undetectable.  Do I wish I had avoided treatment?  Nope, the more "normal" every test is, the better I feel.  For me, treatment is reassuring beyond waiting for some OI or other possibly irreparable damage.  Further, since Atripla amounts to one pill a day, I dont' feel that treatment is a big commitment.  I've already made similar commitments which are more onerous such as eating 3 times a day.

[megasept]

[quote For me, treatment is reassuring beyond waiting for some OI or other possibly irreparable damage.  Further, since Atripla amounts to one pill a day, I dont' feel that treatment is a big commitment.  I've already made similar commitments which are more onerous such as eating 3 times a day.
[/quote]

Hi, while Ann talks about adherence, I was not talking about commitment or adherence.

You're right! Taking one pill (or even many more) daily is far from onerous. There are folks in Africa and Asia who would love to have our meds to take (the world's highest adherence rate).

The issue is not convenience, nor quality of life side effects; the issue is what harm to your liver and heart vs. harm of non-treatment. There's a balance. Otherwise, we all should be on meds from known infection until total treatment failure. When you realize that POZ may live decades post-diagnosis, this concern is valid. I take a baby aspirin daily for my heart. Most of us should do the same. We may live more years infected than not.

You benefit from meds. For five years I did too. Our friend will benefit. But he must not be miseducated into believing the decision for meds should be automatic, based on infection alone---it should not. I say this even though I believe he should/will go on meds in the immediate future.

  -megasept

[fondeveau]

But he must not be miseducated into believing the decision for meds should be automatic, based on infection alone---it should not. I say this even though I believe he should/will go on meds in the immediate future.

I don't know that anyone is saying that meds should be automatic based on infection alone.   Rather, that more doctors are recommending meds at the 350 mark.  Likewise no one should have such a fear of meds as to avoid them and thus harm themselves.  Rather, it is indeed a decision to be made in close consultation with your physician.

[lifechanging2007]

hey poz 3-06-07

first of all i understand what 03-06-07 stands for its the time you learned the news. right? well for me it was 01-24-07 (a day i will remember for the rest of my life (if you want to know more read the first thread ive written "how 24 of january changed my life"
secondly, i totally understand what you arte going through because my first numbers where similar to yours :
i was infected last year (as for my counts you can check my signature)

after my second blood counts it was a hard decision to make. my vl was >800k and CD4 =241=13%
after spending long nights reading, researching and contacting doctors worldwide i decided to start meds. my decision was made on several issues (and once again this is theories and not necessary facts) :

1-the immunity system is the most vulnerable during the first months of infection this is when the most damage is caused and the most of CD4 is distroyed plus this is when HIV begins to spread in whole your body.

2-it is true that your body will fight back and your viral load will eventually decrease but i mean COME ON!!! 800k and in your case 750k is a big number and is it improbable that you will be under 1000. the reason for that could be that the strain hat we have is a nasty one.

3-its true that noone died from aids in the first year of infection but i am not willing to risk it. with meds you know you are in control at least at the short term.

However and after starting meds there is few points that you should take into consideration (and once again this depends on each person):

1-it is a commitment.
2-some side effects are not pleasant and believe me they are not pleasant (the first month i slept during the majority of the day plus i had nausea 24/7 and i had this scary rash for 2 days)

whatever your decision is it is YOUR decision and yours only wich freaks me more because not knowing the best for you is scary right i mean would anyone study infectious diseases for years and then tell you WELL IT IS YOUR DECISION..I WAS LIKE "WHAT THE FUCK IS MY DOCTOR SAYING...IS HE GIVEN ME THE CHOICE?'

yes it is a nasty disease in all its ways...i never thought that waking up in the morning will be  a challenge.....but hey isn't life a bumpy ride of challenges.

[bimazek]

If i were in your shoes I would have two more blood tests and see if my numbers were better or worse, if worse i on both i would start, if worse on only one, better on one i would wait and if better on both wait

below 200 start immediately or VL above 150,000 start asap

so you can relax and get some more blood tests

good luck

[JPinLA]

Hi there!  I agree with most.  I would get at least one more if not two more blood tests to establish either a trend or that you've reached some sort of equilibrium.

I started when I was just below 300 T4s with 3 blood tests (indicating a consistent downward trend in Ts and upward VL).  That was my choice and is was congruent with discussions with my physician. 

I agree too that you have time to make your choice.  When and if you do, be sure you are as ready as you can possibly be and go in with a positive mind!

JP