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Author Topic: CD4 238, 9,5%, VRL 290 000 copies/ml. Should my lover start using HART?  (Read 3240 times)

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Offline Rabbit

  • Member
  • Posts: 40
Dear advisors,

I am writing to you to ask for help. My lover is a H positive. He is fine at this moment. He is still working as usual athough he is slim. He is 1,74 m tall but his body weight is only 60 kgs. His apetite is good. About 3 months ago he could not sleep well but now his sleeping is very good.

He has just told me his lab reults today. They are  : CD4 238, %9.5, VRL 290 000copies/ml.

Could you please tell me when is the best time for my lover to start HART and which HART regime is suitable for my lover ?

I am very grateful to you for your advice.

I look forward to hearing from you.

Rabbit

Offline thunter34

  • Member
  • Posts: 7,311
  • His name is Carl.
I would seriously consider it.  He's skating pretty close to the magic mark of 200, below which comes an official AIDS diagnosis and the opportunity to be at risk for some very serious opportunistic infections. 
AIDS isn't for sissies.

Offline Rabbit

  • Member
  • Posts: 40
Dear Thunter 34,

Thank you for your help. I am sorry for a mistake. His VRL is 20 900 copies/ml not 290 000 /ml. Do you change your advice?

Best wishes,

Rabbit

Offline thunter34

  • Member
  • Posts: 7,311
  • His name is Carl.
Not really....not if the CD4 numbers are correct.  Both the overall number (234) and the %(9.5) are getting fairly low.  Most information I have read stated that doctors prefer to get their patients going on HAART treatment once their CD4 number falls below 350- but above 200.  The meds are pretty toxic and the further down one's immune system is, the harder it can be for the body to bounce back.  I stand by my earlier recommendation.  I say for him to see his doctor and seriously discuss this.

As for which regimen to take...that's something that can't be declared over the internet.  It depends on several factors, not the least of which would be lifestyle.  Is he the sort that would adapt well to once daily dosing?  Twice daily?  The doctors should also run a genotype test on him to determine if he has any pre-existing resistance to any of the medications.
AIDS isn't for sissies.

Offline Rabbit

  • Member
  • Posts: 40
Dear Thunter,

My lover is going to take a training course on his field, which will last about 3-4 months. He worries  starting medications will make him sick and he may not take the course. Any helps?

Thank you very much.

Rabbit

Offline whizzer

  • Member
  • Posts: 363

 He worries  starting medications will make him sick and he may not take the course.


PCP, should it develop, will make him much sicker than the meds might.  With a CD4% of 9.5, he is well into AIDS territory.

What does his doctor recommend?

Offline anniebc

  • Member
  • Posts: 5,939
  • AM member since 2003
Hi Rabbit

I'm surprised his Doctor hasn't called him in for a chat already, does he have a Doctor who specialises in HIV?...If he hasn't then he really needs to get one.

Hugs
Jan
-----------------------------------------------------------------------
Never knock on deaths door..ring the bell and run..he really hates that.

Offline Matty the Damned

  • Member
  • Posts: 12,228
  • Ninja Please
Yes already, with the HAART he should start! Like the others Matty the Damned wonders if your partner's doctor has recommended a combo?

MtD

Offline Rabbit

  • Member
  • Posts: 40
Dear all,

Thank you for your advice. My lover is living in Vietnam, where the HIV doctors are not very good. Most of the HIV doctors are the general doctors from hospitals.

I am living in the UK and I have just called him to have a chat with him about the medications. He really wants to know about your advice about this and the best way to avoid resistance.

I am very grateful to you.

Best wishes,

Rabbit

Offline newt

  • Member
  • Posts: 3,878
  • the one and original newt
The best way to avoid resistance is to take the meds on time every time.

Avoiding resistance is closely related to good adherence

Your man's numbers indicate it is time to start treatment if he decides. Wolrd Health Organisation, UK and all other guidelines recommend treatment at a CD4 count around 200. His CD4% is kinda low (lower than you would expect for a CD4 count of 238).

But, if he decides to wait til he gets back from his trip before looking at combo then some co-trimoxazole (Septrin, Bactrim, TMP-SMX) to prevent the serious pneumonia PCP may be a good idea.

- matt
"The object is to be a well patient, not a good patient"

Offline Rabbit

  • Member
  • Posts: 40
Dear all,

thank you very much for your kind help.

I have another question. Do my lover really need a resistance test before starting medications? If he starts the medications without this test, is there any harm?

Once again, I am highly appreciated your advice.

Rabbit

Offline BT65

  • Global Moderator
  • Member
  • Posts: 9,912
I had a resistance test when my numbers fell months ago, but I'm assuming I'll probably have another one soon.  How long is he in Vietnam?  Three months?  I feel like the other poster above, that he should start Bactrim or something to avoid getting PCP.  He really needs to think about going on HAART also.  That's a tough situation, being in a country where, according to you, there are doctors who aren't all that familiar with HIV.  Is there not one doctor he can go to  to perhaps get started on something?
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Offline LatinAlexander

  • Member
  • Posts: 599
  • Bogota, Colombia
My Vote:; YES. If he doesn't have a doctor, he should get one NOW. The % is not good.

Sid eeffects? Well, it depends. None of us know for sure. That is really a unique experience. But he is getting to close to the offixal AIDS definition.

Alex
Poz since Jul 19 2006
Initial numbers : CD4-250 VL 3500
First labs after HAART (Dec 04-2006) : CD4-432 VL-<40 (Undetectable)  cd4%=25.11%
Started HAART: Combivir+Efavirenz Aug 26 7:38 pm
Feb 08 2007 - Gradually stopping HAART cause of Myalgia. Protecting Efavirenz. Stopped Efavirenz, ahead with Combivir....
February 17 Combivir stopped.
April 3 -07 : Started ddi+3tc+efavirenz...
Gay and positive (What a lack of Identity...:) )
Looking for my Ben....

Offline madbrain

  • Member
  • Posts: 1,208
  • No longer an active member
    • My personal site
Dear advisors,

I am writing to you to ask for help. My lover is a H positive. He is fine at this moment. He is still working as usual athough he is slim. He is 1,74 m tall but his body weight is only 60 kgs. His apetite is good. About 3 months ago he could not sleep well but now his sleeping is very good.

He has just told me his lab reults today. They are  : CD4 238, %9.5, VRL 290 000copies/ml.

Could you please tell me when is the best time for my lover to start HART and which HART regime is suitable for my lover ?

I am very grateful to you for your advice.

I look forward to hearing from you.

Rabbit

Actually he already has AIDS due to a CD4% of less than 14.

Consistent with the 1993 revised classification system, CDC has also expanded the AIDS surveillance case definition to include all HIV-infected persons who have less than 200 CD4+ T-lymphocytes/uL, or a CD4+ T-lymphocyte percentage of total lymphocytes of less than 14. This expansion includes the addition of three clinical conditions

Quoted from :
http://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm

I wonder what kind of doctor would tell him to stay off meds at this point.

Offline Rabbit

  • Member
  • Posts: 40
Dear all,

I am very moved for the advice from all of you, which really help us. I am going to help my lover about the time table of taking medicine and all what he may needs from me. As a lover of him, I am not H positive, could you please tell me what I should do to help him at this moment? Sometime, I do not know what to do to help him.

Your help would be highly appreciated.

Rabbit

Offline LatinAlexander

  • Member
  • Posts: 599
  • Bogota, Colombia
Just love him. When you feel that HIV is taking your life away, you feel extremely lonely. Make sure he knows YOU love him.

Alex
Poz since Jul 19 2006
Initial numbers : CD4-250 VL 3500
First labs after HAART (Dec 04-2006) : CD4-432 VL-<40 (Undetectable)  cd4%=25.11%
Started HAART: Combivir+Efavirenz Aug 26 7:38 pm
Feb 08 2007 - Gradually stopping HAART cause of Myalgia. Protecting Efavirenz. Stopped Efavirenz, ahead with Combivir....
February 17 Combivir stopped.
April 3 -07 : Started ddi+3tc+efavirenz...
Gay and positive (What a lack of Identity...:) )
Looking for my Ben....

Offline Rabbit

  • Member
  • Posts: 40
Dear Alex,

Thank you for your message. Yes, I do love him. and I am sure that never will I stop loving him. I understand that love should be a good remedy for him and for everyone having bad fate. The only difficulty for me at this moment is I am not in my country, I am abroad and he is working in my country.  :(

Best wishes to you.

Rabbit

Offline cokaine

  • Member
  • Posts: 42
  • I AM THE ORIGINAL DIVA, okaaayy
Hi Rabbit

I think you should tell your bf to consider starting meds or at least talk to a doctor about starting in the near future. I was 250 one week and 3 weeks later went down below 200 and I have an official AIDS diagnosis. I had to start immediately and felt extremely weak and symptoms of PCP when I started my meds and bactrim. a year later I was doing much much better with minimal side effects. Good luck in your bf's decision.

cokaine

Offline gerry

  • Member
  • Posts: 522
  • Joined AM Feb 2003
If he is living in Vietnam only temporarily and returning to the UK, it might be better to get his treatment started when he returns.  Treatment options are quite limited in Vietnam so recommending a "good" medication combo will depend mostly on what's available.  I am assuming that the cheapest regimens (nevirapine, zerit, epivir) are the ones that would be mostly available.  While they are a good combo, the UK would be able to offer others as well with less potential long-term side effects (such as lipoatrophy from zerit).  I am assuming as well that resistance testing might have a very limited availability in Vietnam.  I agree with Matt about starting co-trimoxazole to prevent PCP while he is waiting, if he decides to wait.  The relatively low viral load is encouraging that he may have time to spare until he can get his health care access situated.

Offline AustinWesley

  • Member
  • Posts: 815
    • HIV Discussion Group on Myspace!
Dear Thunter,

My lover is going to take a training course on his field, which will last about 3-4 months. He worries  starting medications will make him sick and he may not take the course. Any helps?

Thank you very much.

Rabbit

Hey Rabbit,

First off, I think it's great you are involved and taking time to help your partner and being involved.

I definitely think it's time he should start meds according to those numbers and most HIV docs would likely advise him to by now.  Of course it's still his choice.

I would recomend he get a genotype run if he hasn't already to check for any resistence issues prior to starting meds.

His % is low and the CD4 isn't great.  The VL isn't out of control and I'd bet he'd have excellent results to the meds.

While starting them is a scary event for everyone, I can tell you that I had virtually no issues after the 1st week.   All I had was a slight dizzy feeling for a few days which is a distant memory now.

Probably starting on a Friday or long weekend would be best, giving him a chance to adjust.    I was absolutely terrified after reading one horror story after another and in my case it turned out to be a big non event.

Good luck to you both!

Wesley
Diag. 3/06  Infected aprx. 2 mo. Prior
Date        CD4   %      VL
4/6/06     627    32    36,500     NO MEDS YET!
6/7/06     409    27    36,100
8/23/06   408    25     22,300
1/2/07     354    23     28,700
2/9/07     139    30     23,000  Hep A Vaccine same day???
2/21/07   274    26     18,500 
3/3/07    RX of Truvada/Sustiva Started.
4/5/07    321     27      Undectable 1st mo.  
5/16/07  383     28    Undectable 2nd mo.
8/10/07  422     32   UD <48 on new scale!

 


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