new diagnosis, still on ARS, treatment Truvada + Kaletra

[songs06]

hi, i just got my diagnosis not one month ago while i was still on my acute retroviral syndrome. (i work in a hospital, and i studied about STDs, that s why i was suspicious about hiv in the first place. i was afraid my flu like syndrome is ARS, but chance was not too high. but in the end my suspicion was true and i was shocked.)
for my story you can check: http://forums.poz.com/index.php?topic=42909.0

now my first lab results were really bad. (because virus is still reproduce in my blood really fast.) my CD4 is 259 (which is low for a starter), and my viral load is 2.3 million (which is high for anyone!) even i got hiv just 2 months ago, my doc wants to start treatment while i am still on ARS because my body seems to not fighting the virus. it has been 6 weeks and i am still feeling like shit, not standing up, throat ache, millions of swollen glands and etc... it is kinda bad because i know when i start the meds i have to use them for the rest of my life. and i also know acute and chronic side effects. (i am 25 years old btw.)

now in my country, we don't have lots of drug options. my doc said we will start truvada and kaletra. i know it is ok for a first starter (RTI+Protease inh.) but it says in official drug site that when you use this combination, truvada makes kaletra metabolise less and makes it higher in the blood. so i am not sure my ID doesn't know about it, he probably will but still choose that. but is there anyone who was using these drugs and had any problems? i know ARD effects everyone differently, like HIV itself. but i really appreciate to hear your experiences with these drugs, even a minor side effect is important for me. i know i will have a hard month after i start my treatment, but how long it goes before my body starts to get tolerance?,

edit: also do you think i start the treatment oo early even my CD4 count is low? if i wait like 3 months, maybe my CD4s get better and viral load gets lower? i am so much confused about when to start treatment.

[newt]

Hello

The interaction between Truvada and Kaletra is not serious, it's a standard combination in many countries and very effective.

Your CD4 is low and viral load sky high because this it how it goes in acute HIV infection. It is likely that in a few weeks your CD4 count will rise and viral load drop. But if your CD4 count stays low, like below 250-350, your doc may (and rightly) recommend starting treatment.

Some doctors will want to treat during primary infection because it seems beneficial long term, or because your body's reaction to the viremea is making you seriously ill. Whether and when to treat during primary infection is incompletely understood, and therefore something to discuss with your doc.

Good luck

- matt

[songs06]

thanks newt,
i talk to my ID about treatment. he told me we have to start as soon as possible. i wanted to wait and see my new cd4 count like one month later. but because of my terrible acute syndrome he wanted to start. they don't do that in my country, they mostly wait some months. and there are only few people who can get diagnosis in the acute period. so i will start drugs next week

i still have doubts about kaletra's side effects. i am kinda afraid. using these drugs for several years (with all those side effects) kind of scary. but i know i have no choice. this is HIV, not flu.

[Ann]

Songs, a mate of mine was on Truvada and Kaletra for several years and he didn't have any problems with it. He switched to Sustiva (aka efavirenz) and Truvada - but only because the once a day dosing was easier for him because of his job. He's a commercial fisherman and would sometimes forget his evening dose if he was still out fishing.

He had to take his Kaletra twice a day, but you'll most likely be able to take it once a day. You should be just fine.

Some people experience a bit of diarrhea on this combo (from the Kaletra) but talk to your doctor. He will be able to prescribe loperamide for you if it becomes a problem.

You can read about your meds here.

Good luck - you're going to be ok. Really!

Ann

[songs06]

thank you Ann,
i see truvada + kaletra is a fine combination, and it is commonly used but i still have doubts about starting treatment too early. i know my lab results turn better in couple of months. i like my doctor, but he is young. he always asks for opinion to his professor whom is the best and most famous hiv doctor in my country. my ID told me professor especially told him to start my treatment.
i am also planing to go and do my cd4 count once again in a private clinic and to see it is rising. i know i will start my treatment eventually, there is no escape. but i want to push the date a little further. because i will have a life of a time to use these drugs.

don't you think i should wait like a month to see my new CD4 and viral load before starting to treatment?

[Ann]

You can wait if you want - it's ultimately your decision, not your doctor's. It's very true that your numbers are likely to improve without meds at this point.

There are mixed opinions concerning the severity of a person's seroconversion illness and whether that predicts how quickly or slowly their infection will progress.

I had a severe seroconversion illness fifteen years ago and I'm not on meds yet, although I'm hoping to start this year. While I'm glad I have been able to wait, in the past few years I've been concerned about what on-going damage might be occurring that I'll pay for down the line.

For the first ten to twelve years, I didn't worry about it. I've only worried in the past three as newer studies have emerged - as well as newer studies looking at hiv and aging. (I'll be 50 later this year)

Please note that I didn't know for four years that I had been infected. It was only with hindsight after diagnosis (Feb 2001) that I knew the illness I suffered in May 1997 was my seroconversion illness. I'd never been so ill in my life before or since. And I hope to never be that ill again.

[songs06]

well, finally i decided to start my treatment after one more CD4 test. i believe it will improve. i don't feel like taking a one way road with just one test. problem is CD4 test is quite expensive, so i have to go to public clinic and ask for my ID doctor, and it will take another week. (i know it actually takes 3 hours


another big problem is my PPD (tuberculin test) result is anergic!! i remember a information like i have to get vaccinated and get tested again to see if it is real anergy or negative. do you know what should i do after this stage? i know tuberculosis treatment and ART don't go well together, so i have to cure my TBC first.

AND another idea in my mind, while i am still in my acute retroviral syndrome, how can my skin test could be reactive, come on! i have too low CD4 lymps. i need me CD4 cells to stimulate CD8 cells to get reaction! do you think it is logical to get a PDD test still on acute syndrome? it still sounds stupid to me and this is why it is anergic at all!

even my throat is better now, my depression is worse. i don't know when this "i am unlucky" feeling going to end. but i am afraid one day in the future, there will be wars and bad things on earth, and i won't be able to find drugs and etc. i know i am being paranoid but i am really afraid on relying on drugs to live for whole my life

[mecch]

even my throat is better now, my depression is worse. i don't know when this "i am unlucky" feeling going to end. but i am afraid one day in the future, there will be wars and bad things on earth, and i won't be able to find drugs and etc. i know i am being paranoid but i am really afraid on relying on drugs to live for whole my life

Allow me to unpack things that shouldn't be all run together.
First of all, your numbers and seroconversion.  Your doctor isn't talking out of his butt.  As you say, its common in your country to wait but here we have your doctor recommending a start for you.  I might guess, that if you don't start now, it might be not all that long before you do have to start. Maybe a few months. maybe a year who knows. Even if your viral load drops down, and your CD4 goes up in  few months, I might guess, that your doctor is thinking the set point is NOT going to be fantastic.  Thus, starting now, and having the advantages that do come with quite early treatment.  The HAART will effectively cut your viral load down to zilch pretty quickly, you can count of that.
So what shouldn't be run together is wondering if historic events are going to arrive that might limit your FUTURE access to treatment.  Because, if you need the HAART now, or if you need it in 1 year, it makes no difference applied to this "estimate" of risk you are making about future access.  If there is a catastrophic event in your country and you don't get your drugs, in five years, Well that sucks.  But the fact is, you will have been healthy for those years before the event.   You are going to need the HAART, in other words.  We ALL think about the same thing you are thinking - that HAART is for life.  But it should really NOT be a factor in considering when you start.  Nor should the fear about future unavailability of the medicine.  Without medicine, you will die, long before this hypothetical future unavailability of medicine.

Put simply, a bird in the hand is worth two in the bush.  HAART is the bird in your hand.
http://www.quotegarden.com/worry.html
Do not anticipate trouble or worry about what may never happen.  Keep in the sunlight.  ~Benjamin Franklin
I've developed a new philosophy... I only dread one day at a time.  ~Charlie Brown (Charles Schulz)
Worry never robs tomorrow of its sorrow, it only saps today of its joy.  ~Leo Buscaglia

[songs06]

mecch, thank you for this great reply. i feel kind of better now but i think is misexpressed myself. (because of my broken english, probably i didn't mean my paranoia about future stopping me to start treatment. it is totally another subject. it would be stupid not to start treatment because i won't be finding drugs in the future. (which is not a fat chance.) it is just a subject wandering around my mind these days.

and for the real subject, it is just like you say. my ID thinks my numbers are bad and starts early treatment. but he also said i am one of the really few people they diagnosed in the acute period. in my country, we really have few hiv patients, and almost all of them get diagnosed in the latent period. so they are not that experienced about treating early. they also said they started early treatment 2-3 times before, with patients like me, who is informed about hiv and get diagnosed early, have bad numbers, really bad seroconversion etc... when i said i am going to start, i meant like months not years. i wish i could wait like years, like lots of people. but i know my hiv infection is not that manageable like many. even i might have aids earlier than lots of people. but even one or two months without drugs is important for me (and for my body as well.)

that s mostly because i have infected 2 months ago very this day, i have diagnosed just 3 weeks later, i am hiv positive for like one month. it is too much. this might be the hardest 2 months of my life and i am still suffering, and now i have to start a life long treatment right away. i needed to get my mind ready for such big news. but now i am still struggling about my drug availability, health insurance, depression, my friends and family etc... i actually just wanted to have 2 months but i still didn't tell my ID, which i am going to do next week. i don't know what he is going to tell me.

[mecch]

Well again, these are two separate issues.   

You can deal with the shock and deal with telling people at your own pace and it will take many months. 

If the choice is starting one month later, I don't see how this time will be meaningful for the emotional and psychological issues, but then I also don't think it will make a difference for your long term prognosis either if you wait one month or two months. I believe it is irrational justification, in your context. You are probably simply ambivalent or afraid of the drugs, but saying its more about being HIV positive. Well, the latter is not going to change.

The reason I responded to you is that I was identified in acute seroconversion as well. (But in Switzerland and there are plenty of HIV cases and plenty of experience and no questions about access to med care and HAART, so different context then yours.)

My lowest viral load was just under a million - if I remember it was dropping from several mllion to about 900,000, about 6 weeks after identification.  My doc said it was protocal to wait longer and to go on summer holiday. So I did. Then he did. By August, about 4 months after seroconversion, I had lost drastic amounts of weight and was slowing down considerably.  My vl was up again near 3 or 4 million.  My doc said what your doc said - I was genetically not a good fighter and to simply start the meds.  So I started them that day. I can tell you, my body felt different the NEXT DAY.  It felt more relaxed.   My energy returned within days.  Some complications with skin, and after a few months a combo change.  Also, I had psychological and emotional benefits from starting early.  Nobody really likes to talk about this up side, but its real.

[songs06]

yes, there are two different issues, but one is not that important about my treatment.

i don't feel like ambivalent about drugs, or i am not afraid of them. i know their benefits and all that stuff. even now, when i remember my viral load, i feel like there are billions of viruses in my vein, in my brain, even in my tears. i want to reduce my viral load as soon as possible, and i do believe i will start my treatment in a year. as long as i have high viral load, my body will continue to fight the virus, and inflammation in my body will never end. i do believe benefits of early treatment. but i know it is not a simple aspirin, my body will exhaust from metabolising these drugs for the rest of my life. (sure, virus will be  more exhausting soon) of course one month doesn't change anything, but even one day without drugs seem important to me. it might sound stupid, especially for the people who are on treatment for years.

well i know i can't escape from drugs. after i read your post i felt better about starting actually. i just don't want to rush it. it will be a big part of my life. (with acute and chronic side effects/and with good effects as well.) so i want to breathe first. that's all. i know i am really unlucky. i wish i had better starting numbers, like most people. i feel like the unluckiest in the unlucky people but after reading your post, i really start to dream about feeling better. it has been 8 weeks since my acute syndrome started and i really forgot how was my healthy life.

and another reason why i am not sure starting already is about my insurance. but this is totally another issue. and i am not gonna turn to a denialist. i am not gonna ignore my disease. i will start when i feel ready (this will be really soon). but when i say "ready" i mean not only psychological issues, i also mean my insurance, drug availability in my country and lots of procedure.

thanks for your post mecch, it really helped a lot. i feel a bit better about early treatment already. can i ask how are you VL (probably UD) and CD4 right now? i wonder because we can't fight the bug like most people, means we will always have low CD4?

[songs06]

it has been long time since i wrote this topic.

i finally figured out my drug income, made myself 2 months plus stash. and after just 3 weeks with truvada and kaletra, i ve never missed a dose and my first lab results on treatment is: CD4 count: 401 (from 388) and CD4/CD8 is 0.4 (this was 0.2)

but good thing is my viral load decreased from 150.000 to just 3800! well i am happy to see my ART works fine, better than i expected. And i didn't get serious acute side effects. we will see about chronic side effects in the future.

i just wanted to share my happy news. i am happy i started early treatment in the end. i feel so much better emotionally.