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Author Topic: Starting HAART: Viral Load Predicts CD4 Decline to <350, Takes 2.5 Yrs  (Read 2994 times)

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Offline John2038

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Ok, my last post for today. But as I'm reading about HAART (considering to start soon) came to this very interesting articles which might help some to decide when to start HAART.
My apologizes for this 4th post today.


Viral Load Predicts CD4 Decline to <350, Takes 2.5 Yrs
Nov 2007

HIV Diagnosis at CD4 Count Above 500 Cells/mm3 and Progression to Below 350 Cells/mm3 Without Antiretroviral Therapy
 
The UK Collaborative HIV Cohort (CHIC) Study Steering Committee
 
JAIDS Journal of Acquired Immune Deficiency Syndromes:Volume 46(3)1 November 2007pp 275-278
 
"For untreated patients with CD4 count in the 350 to 500 cells/mm3 range, the rate of AIDS or death is approximately 2.5 per 100 person-years,15 which translates into a predicted 6.1% cumulative risk over an average 2.5 years spent with CD4 count in this range while deferring ART. As expected,16 viral load at baseline was a strong predictor of the length of time taken for the CD4 count to reach <350 cells/mm3, with the median ranging from 0.7 years in those with viral load ≥500,000 copies/mL to 4.7 years in those with viral load <1000 copies/mL."
 
Abstract

Summary: A trial to evaluate the risks and benefits of initiation of antiretroviral therapy (ART) in patients with high CD4 count (eg, ≥500 cells/mm3), in comparison with deferral (eg, to <350 cells/mm3), merits consideration. Two issues for consideration in designing such a trial are the proportion of patients seen in clinics who present with high CD4 count and the time it will take for those randomized to deferring ART to reach a level where ART must be initiated. Among 13,572 patients in the UK CHIC Study presenting since 1996, 3631 (27%) had a count ≥500 cells/mm3. Among 4268 ART-naive patients with at least one CD4 count in the 500 to 650 cells/mm3 range, the median time to <350 cells/mm3 (or start of ART) was 2.5 years, with a range of 2.1 to 3.1 years depending on the analysis approach. Viral load at baseline was a strong predictor of the time taken for the CD4 count to reach <350 cells/mm3, with the median ranging from 0.7 years in those with viral load ≥500,000 copies/mL to 4.7 years in those with <1000 copies/mL. This provides timely background data on ART-naive patients seen in clinical practice to support design of a trial to compare immediate with deferred ART in people with high CD4 count.
 
There has been a growing appreciation that antiretroviral therapy (ART) drugs have sustained and highly durable efficacy in clinical practice,1,2 that accumulation of drug resistance to the 3 main drug classes is slow,3 and that new drugs are becoming available that allow at least 3 lines of non-cross-resistant regimens to be constructed.4 Furthermore, results from the Strategies for Management of Anti-Retroviral Therapy (SMART) trial have found that those randomized to using episodic CD4-count guided ART (and hence interrupting or staying off ART at baseline) experienced a greater incidence of liver, renal, and cardiovascular disease and non-AIDS mortality than those randomized to continuous ART, suggesting that the net effect of ART may be to reduce incidence of these conditions.5 Furthermore, cohort studies have found that the rate of death from many of these events increases with lower CD4 count.6-9 This has led to the view that ART should currently be initiated at a CD4 count of 350 cells/mm3 and that efforts should be made to assess the risks and benefits of starting ART in people with much higher CD4 count (eg, CD4 ≥500 cells/mm3), compared with deferring to a level around 300 to 350 cells/mm3 in a randomized trial.10 Two issues for such a trial are (i) the proportion of patients who are likely to be eligible for the trial, and subsequently for ART initiation at high CD4 count if it is found to be beneficial, and (ii) the time it will take for those randomized to deferring ART to reach <350 cells/mm3, which indicates the length of additional ART use with early initiation, and also allows estimates of the AIDS/death risk in those deferring ART during the period in which the CD4 count is declining to 350 cells/mm3. To help with feasibility assessment and design of such a potential trial, we have studied these issues in the UK Collaborative HIV Cohort (CHIC) Study, a large observational clinic-based cohort study.
 
PATIENTS AND METHODS
The UK CHIC Study has been described previously.11 In brief, the study currently contains clinical information collected as part of routine care on all patients seen since January 1, 1996, in 10 clinics in the UK. This includes information on all CD4 counts and viral load measures, incidence of AIDS diseases, and reports of death. So far, a total of 25,274 patients have contributed to the UK CHIC Study.
 
To understand what proportion of newly presenting ART-naive patients might have a CD4 count sufficiently high to be eligible for a trial of early ART, we assessed the distribution of CD4 count at presentation (ie, the first measured CD4 count for ART-naive patients entering the clinic) for all patients presenting within the period 1996 to 2005, inclusive. Generalized linear models with log link and Poisson error (using generalized estimating equations [GEE] with an unstructured covariance) were used to assess unadjusted (1 univariable model for each covariate) and adjusted (multivariable model) relative risks for the association between various covariates and the probability of the CD4 count at presentation being ≥500 cells/mm3.12
 
For the main analysis of the time to fall from above 500 cells/mm3 to below 350 cells/mm3 in ART-naive patients, we included ART-naive patients who experienced at least 1 CD4 count in the 500 to 650 cells/mm3 range after January 1, 1996 (only patients alive after this date are included), and followed from the time of the first such count until the first CD4 count <350 cells/mm3 or start of ART, whichever occurred first. The upper limit of 650 cells/mm3 was chosen because it was felt that patients entering a trial would be likely to be in this range rather than at a higher count. We also considered variations of the analytical approach. All analyses were performed using SAS version 9.1 (Statistical Analysis Software, Cary, NC).
 
RESULTS
 
CD4 Counts in Newly Presenting and Current ART-Naive Patients

Of a total of 13,572 patients presenting in the period 1996 to 2005, 7285 (54%) were men who acquired HIV through sex with another man (MSM), 422 (3%) acquired HIV through injection drug use (IDU), 5084 (37%) acquired HIV through heterosexual sex, and 781 (6%) were other or unknown; 3583 (26%) were female; 7111 (52%) were of white ethnicity, 3778 (28%) were of black African/black non-Caribbean ethnicity, and the remaining 2683 (20%) were of other or unknown ethnicity. The median age at presentation was 34 (interquartile range [IQR]: 29 to 39). At presentation, 3631 (27%) had a CD4 count ≥500 cells/mm3, 1852 (51%) of which fell in the 500 to 650 cells/mm3 range. The median viral load (measured on the same day or within 6 months before the CD4 count, n = 9639) was 10,400 copies/mL (IQR: 1700 to 46,000), with a breakdown as follows: <1000 copies/mL, n = 959 (10%); 1000 to 9999, n = 1830 (19%); 10,000 to 49,999, n = 2481 (26%); 50,000 to 99,999, n = 1271 (13%); and ≥100,000, n = 3098 (32%). Factors associated with presenting at CD4 ≥500 cells/mm3 were assessed in a multivariable model (Table 1). Older age, being a heterosexual male, and being of black African ethnic origin, and presentation before 2000 were all strongly independently associated with a lower chance of presenting at a CD4 count ≥500 cells/mm3.
 
In addition to the prevalence of CD4 count ≥500 cells/mm3 at presentation, we also considered the prevalence of CD4 count ≥500 cells/mm3 among naive patients under follow-up on July 1, 2005. Nine hundred fifty (38%) of all 2510 ART-naive patients under follow-up had a CD4 count ≥500 cells/mm3 (of which 512 [54%] were in the 500 to 650/mm3 range; median viral load 10,000 copies/mL, IQR 1600 to 36,000). A further 769 (31%) had a CD4 count in the 350 to 500 cells/mm3 range and 791 (32%) <350 cells/mm3.
 
To illustrate the sensitivity of this estimate to differences in definition, we considered the effect of the following changes in the approach to the analysis on the median time to CD4 count <350 cells/mm3 or start of ART: (i) restricting eligibility for analysis to those never previously measured below 500 cells/mm3 (median, 2.7 years; IQR: 1.1 to 5.3); (ii) changing the definition of the endpoint so that we required 2 consecutive values <350 cells/mm3 instead of 1 only (median, 3.1 years; IQR: 1.3 to 6.0); (iii) expanding eligibility to all those with a CD4 count ≥500 cells/mm3 while ART-naive, instead of <650 cells/mm3, and defining the baseline as the date of the first such count (median, 2.9 years; IQR: 1.2 to 6.0); (iv) basing the analysis on those with first CD4 count at presentation of 500 to 650 cells/mm3 (median, 2.1 years; IQR: 0.7 to 4.6); and (v) censoring at the start of ART, instead of considering this as part of the endpoint (median, 3.0 years; IQR: 1.5 to 5.8). Finally, by defining the baseline as January 1, 1998, and including all ART-naive patients with CD4 count 500 to 650 cells/mm3 (n = 292), the median time was 3.0 years (IQR: 1.6 to 5.7).
 
We also assessed factors associated with the time to <350 cells/mm3 or start of ART in Cox models. Lower CD4 count at baseline (adjusted relative hazard [RH] per 50 cells/mm3 higher: 0.90; 95% confidence interval [CI]: 0.84 to 0.96; P = 0.001), lower CD4 count nadir (RH per 100 cells/mm3 higher: 0.86; 95% CI: 0.80 to 0.92; P < 0.0001), and higher baseline viral load (RHs of 1.71 [95% CI: 1.39 to 2.10], 2.29 [95% CI: 1.87 to 2.81], 2.97 [95% CI: 2.36 to 3.73], 4.62 [95% CI: 3.70 to 5.77], and 7.98 [95% CI: 5.92 to 10.77] for viral load 1000 to 9999, 10,000 to 49,999, 50,000 to 99,000, 100,000 to 499,999, and >500,000 cps/mL, respectively, relative to <1000; P < 0.0001 in each case; Figure 1B) were associated with a raised rate of reaching the endpoint, as was older age (RH: 1.07 per 10 years older; 95% CI: 1.00 to 1.13; P = 0.04). Females were also at higher risk. However, this appeared to be attributable to the greater tendency to start ART early on account of pregnancy, because this gender effect was not present when we censored at early ART initiation rather than considering it as part of the endpoint. There was no significant effect of race/ethnicity or risk group.
 
DISCUSSION

Our results indicate that 27% of newly presenting patients in large UK clinics have a CD4 count ≥500 cells/mm3. The proportion was highest in MSM and was also higher in females infected heterosexually and all IDUs, compared with males infected heterosexually. It was also higher in whites and those of other ethnicity, compared with those of black African origin. Furthermore, of ART-naive patients under care in July 2005, 38% had a CD4 count ≥500 cells/mm3. These proportions suggest that a trial of immediate (vs. deferral until reaching a CD4 count of around 300 to 350 cells/mm3) therapy in patients with CD4 count ≥500 cells/mm3 should be relevant to a substantial proportion of individuals presenting with HIV. As testing for HIV becomes more mainstream and widespread, people should be diagnosed earlier in their infection, and these proportions would be expected to increase somewhat. Indeed, we identified a greater chance of the CD4 count at presentation being ≥500 cells/mm3 in those diagnosed after 2000 than before.
 
Our estimates suggest that the median time it takes for the CD4 count in a person with a level in the 500 to 650 cells/mm3 range to fall to below 350 cells/mm3 or to start ART is 2.5 years, with a range of 2.1 to 3.1 years depending on the analysis approach. There was, however, a wide variability among patients-our main analysis suggests 10% with times of >8 years. We are not aware of previous estimates directly comparable with this. The absolute rate of CD4 count decline has been found to be greater at higher counts13 and, consistent with this, has been generally modeled as linear on a square-root scale.14 Our results suggest that initiating ART at CD4 counts above 500 cells/mm3 would increase the time that patients would potentially spend on ART by approximately 2.5 to 3 years on average, compared with waiting to start ART until the count has fallen below 350 cells/mm3. For untreated patients with CD4 count in the 350 to 500 cells/mm3 range, the rate of AIDS or death is approximately 2.5 per 100 person-years,15 which translates into a predicted 6.1% cumulative risk over an average 2.5 years spent with CD4 count in this range while deferring ART. As expected,16 viral load at baseline was a strong predictor of the length of time taken for the CD4 count to reach <350 cells/mm3, with the median ranging from 0.7 years in those with viral load ≥500,000 copies/mL to 4.7 years in those with viral load <1000 copies/mL.
 
In summary, we have provided background data on ART-naive patients with CD4 count ≥500 cells/mm3 seen in clinical practice to support the design of a trial to compare immediate ART with deferral to a CD4 count around 350 cells/mm3.

Offline keyite

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Re: Starting HAART: Viral Load Predicts CD4 Decline to <350, Takes 2.5 Yrs
« Reply #1 on: December 08, 2007, 03:57:46 PM »
Thank you, this is very interesting and highly thought-provoking for those of us not yet on meds, even if these are average time-spans and subject to significant individual variability.

Offline thunter34

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Re: Starting HAART: Viral Load Predicts CD4 Decline to <350, Takes 2.5 Yrs
« Reply #2 on: December 08, 2007, 04:22:36 PM »
My apologizes for this 4th post today.

Yeah.  Don't make the mods give you your own special Research News thread.
AIDS isn't for sissies.

Offline dingowarrior

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Re: Starting HAART: Viral Load Predicts CD4 Decline to <350, Takes 2.5 Yrs
« Reply #3 on: December 08, 2007, 07:20:38 PM »
can someone explain in english? laymen terms please.  ???

Offline vokz

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Re: Starting HAART: Viral Load Predicts CD4 Decline to <350, Takes 2.5 Yrs
« Reply #4 on: December 09, 2007, 03:10:19 AM »
Dingo,

This is simply reporting on one small part of a wider UK Collaborative HIV Cohort (CHIC) study to evaluate the additional benefit of starting antiretroviral therapy at a CD4 cell count of around 500 cells/mm3 .. and to see if the potential benefits of such an early initiation of HAART outweighs the risks.

In this particular report they are concluding that the AVERAGE patient (with quite substantial variations) starting treatment with an absolute CD4 count above 500 cells/mm3 would have to start that treatment two and a half years earlier than if they had waited to start treatment with a CD4 cell count of 350 cells/mm3.

The report on this phase isn’t advocating an earlier commencement of treatment. It is simply part of the preparatory work to design a randomised controlled trial to compare the long-term outcomes in patients starting therapy with CD4 cell counts above 500 cells/mm3, compared to patients who defer starting treatment until their CD4 cell counts are in the region of 300 – 350 cells/mm3 (a report on a previous phase of the preparatory work – ‘Rate of AIDS disease or death in HIV-infected antiretroviral therapy-naïve individuals with high CD4 cell count’ - showed clear differences in the risk of death).

Offline John2038

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Re: Starting HAART: Viral Load Predicts CD4 Decline to <350, Takes 2.5 Yrs
« Reply #5 on: December 09, 2007, 06:08:16 AM »
None technical summary ( http://www.aidsmap.com/en/news/0ABDF068-9ABB-4D73-8577-FC46D2207B45.asp )

Analysis of data from a large UK HIV cohort has shown that, amongst untreated patients with CD4 cell counts above 350 cells/mm3, the higher the current CD4 cell count, the lower the risk of AIDS and death:

patients with a CD4 cell count between 500 – 649 cells/mm3 were 55% more likely to develop an AIDS-defining illness than patients with a CD4 cell count above 650 cells/mm3.

Individuals with a CD4 cell count between 200-350 cells/mm3 were five times more likely to experience an AIDS-defining illness or die than individuals with a CD4 count above 650 cells/mm3.

The investigators suggest that their finding “contributes to the rationale for evaluating the risk/benefits for initiation of antiretroviral therapy in patients with high CD4 cell count (e.g. above 500 cells/mm3) in a randomized controlled trial, for example comparing with deferral to 350 cells/mm3.”

Clinicians are increasingly optimistic that, thanks to the success of antiretroviral therapy, and the prospect of new classes of anti-HIV drugs, HIV-positive individuals have the opportunity of living a normal life-expectancy.

A 25 year-old diagnosed with HIV and treated with HIV therapy can expect to live to his 60s

This is leading some investigators to suggest that the potential benefits of early initiation of anti-HIV treatment outweigh the risks.

For this issue to be adequately addressed it will be necessary to design a randomised controlled trial, comparing outcomes in individuals who start treatment with a CD4 cell count of 500 cells/mm3 with those who start treatment in line with current treatment guidelines. Looking at the risk of AIDS or death in patients with higher CD4 cell counts (above 350 cells/mm3), would, investigators from the UK Collaborative HIV Cohort (UK CHIC), provide useful background information for the design of such a study.

Over 25,000 patients have now been enrolled in the UK CHIC, which was established in 1996. The current analysis included 17,609 patients who were antiretroviral-naïve. The rate of AIDS-defining illness and death (from all causes, the data did not allow the exact cause of death to be determined) were analaysed according to current CD4 cell counts. A total of 30,313 person-years of follow-up was available for analysis.

In all, 1,557 AIDS-defining events or deaths were recorded (overall rate, 5.1 per 100 person years). The investigators found that, even amongst patients with a CD4 cell count above 350 cells/mm3, the risk of AIDS or death fell at higher CD4 cell counts. Indeed, patients with a CD4 cell count between 500 – 649 cells/mm3 had an AIDS or death rate ratio of 1.55 (95% confidence interval [CI], 1.11 - 2.17) compared to patients with a CD4 cell count of 650 cells/mm3 or above, a statistically significant difference (p = 0.01).

The risk of AIDS or death was even higher for patients with lower CD4 cell counts. For patients with a CD4 cell count between 350 – 499 cells/mm3 the rate ratio of AIDS was 2.49 (95% CI, 2.16 - 2.82, no P value provided), and the rate ratio for patients with a CD4 cell count between 200 cells/mm3 (the current threshold for the initiation of HIV therapy in the UK) and 349 cells/mm3 was 4.91 (95% CI; 4.39 - 5.43).

Unsurprisingly, patients with a CD4 cell count between 50 – 199 cells/mm3 had a much higher rate ratio of AIDS or death at 20.81 (95% CI, 18.8 - 22.8), with individuals with a CD4 cell count below 50 cells/mm3 having a rate ratio of 102.71 (95% CI, 92.2 - 113.3) .

The investigators found that for patients with a CD4 cell count above 350 cells/mm3, each additional 100 cell/mm3 increase in CD4 cell count significantly reduced the risk of AIDS or death(p < 0.0001). Factors associated with an increased risk of AIDS or death were each 1 log10 increase in viral load (p = 0.006), each additional ten years of age (p = 0.001), and injecting drug use (p = 0.002).

When the investigators controlled for these additional factors, they still found that each additional 100 cell/mm3 increase for patients with a CD4 cell count above 350 cells/mm3 was protective against AIDS and death (p < 0.001).

In all, 289 AIDS-defining events occurred in patients with CD4 cell counts above 350 cells/mm3. When the investigators examined these in more detail, they found that 20% of cases were Kaposi’s sarcoma, 20% oesphageal thrush, 14% tuberculosis, 6% herpes simplex, 12% recurrent bacterial infections, 6% PCP pneumonia, 5% cryptosporidiosis, and 4% lymphoma.

Although the highest incidence of death and AIDS-defining events occurred at CD4 counts below 200, analysis of the rate of death per 100 person-years of follow-up showed that the rate of AIDS or death fell from 4.91 per 100 person-years (confidence interval 4.39–5.43) in those with CD4 counts between 200-349 to 2.49 per 100 person-years (CI (2.16–2.82) in those in the 350-500 band and 1.54 per 100 person-years (CI 1.22–1.86) in the 500-650 band.

The investigators stress that although the risk of AIDS or death for patients with a CD4 cell count above 350 cells/mm3 is low compared to individuals with lower CD4 cell counts, “the risk at higher counts is not negligible.” As the efficacy of anti-HIV therapy has improved, and drugs become more potent, tolerable and easy to take, the investigators believe “it is appropriate to focus on risk at these higher levels.”

“Our findings suggest that risk of AIDS or death might be reduced by using antiretroviral therapy to raise CD4 cell counts even among patients with higher CD4 cell counts”, add the investigators. They also note that the SMART treatment interruption study found that individuals with higher CD4 cell counts had a lower risk of some serious non-AIDS illness, such as heart, kidney and liver disease as well as some non-AIDS defining cancers.

“In summary, the trend of decreasing rate of AIDS and death with higher CD4 cell count is present across the CD4 cell count range above 350 cells/mm3 and may even persist across CD4 cell counts above 500 cells/mm3. These are important observations for consideration in a randomised controlled trial of early antiretroviral therapy.”

« Last Edit: December 09, 2007, 06:10:42 AM by John2038 »

Offline vokz

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Re: Starting HAART: Viral Load Predicts CD4 Decline to <350, Takes 2.5 Yrs
« Reply #6 on: December 09, 2007, 06:36:27 AM »
And there, as if by magic, is a summary of aforementioned Rate of AIDS disease or death in HIV-infected antiretroviral therapy-naïve individuals with high CD4 cell count.

Offline John2038

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Re: Starting HAART: Viral Load Predicts CD4 Decline to <350, Takes 2.5 Yrs
« Reply #7 on: December 09, 2007, 02:37:47 PM »
Yet another study, highlighting important conclusions about starting a treatment at CD4>350

http://www.hivandhepatitis.com/2007icr/ias/docs/083107_a.html

Results

    • Absolute CD4 cell counts in the lower strata failed to catch up to those seen in the higher strata, even though CD4 cell increases were similar for all groups throughout the 144 weeks.

    • Baseline CD4 naive-to-memory cell ratios (median 0.21, 0.45, 0.57, 0.66, and 0.81, respectively) were lower in the lower strata.

    • This remained the case at weeks 48, 96, and 144 (median 0.43, 0.50, 0.68, and 0.80, 0.69, respectively, at the end of follow-up).

    • T-cell subsets in patients with baseline CD4 counts greater than 350 cells/mm3 approached or were within the normal range for absolute CD4 cell, CD4 naive cell, and CD4 memory cell counts, and for CD4 naive-to-memory cell ratios.

    • In contrast, patients who began HAART with 350 cells/mm3 or less generally failed to regain the normal values seen in the general population.

    • HIV positive patients' median CD4-to-CD8 cell ratios at baseline (0.05, 0.18, 0.34, 0.49, and 0.64, respectively) were lower than those of HIV negative control subjects (2.02).

    • CD4-to-CD8 cell ratios remained low at week 144, especially in subjects with baseline CD4 counts of 350 cells/mm3 or lower (0.40, 0.51, 0.69, 0.91, and 1.19, respectively).

Conclusion

"T-cell deficits were most notable for subjects in the lowest CD4 cell stratum, whose median CD4 naive-to-memory cell ratio after nearly 3 years remained below the baseline values of other strata," the study investigators reported. "Median CD4-to-CD8 ratios for all strata appeared to be lower than HIV-negative controls, especially those in the lower strata."

Based on these results, they concluded, "These data support consideration of earlier initiation of ART (>350 CD4 cells/mm3) to allow restoration of normal T-cell populations."

Offline FiercenBed

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Re: Starting HAART: Viral Load Predicts CD4 Decline to <350, Takes 2.5 Yrs
« Reply #8 on: December 10, 2007, 02:15:23 PM »
i learned a new word id never heard of before from appleboy and his virxsys trial. that is "nadir'. thatz the lowest number of cd4's youv ever had even after a rise from treatment. a previous goodle search  talks about how having a low nadir effects future treatment of your hiv. unfortunatly as appleboy found out his low nadir prevented him from taking part in a research program. it would appear that increasing the treatment target from 200 to 350 would be a good idea. i had a low nadir and cant seem to get past 400.

Offline Miss Philicia

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Re: Starting HAART: Viral Load Predicts CD4 Decline to <350, Takes 2.5 Yrs
« Reply #9 on: December 10, 2007, 02:44:48 PM »
ttl;dr
"I’ve slept with enough men to know that I’m not gay"

Offline NYCguy

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Re: Starting HAART: Viral Load Predicts CD4 Decline to <350, Takes 2.5 Yrs
« Reply #10 on: December 13, 2007, 03:32:33 PM »
I realize two people isn't much of a study, but there's nothing like personal experience...my bf and I were infected within a few months of each other (one got it then gave it to the other).  His T's dropped quickly and by the time we found out what was going on he was just under 200 and started ART right away.  Mine never dropped below 500 but % went from 30 to 20 in 1 month and VL over 250,000 so I started too - within about a month of his starting.

Almost exactly one year later, his Ts have yet to break 400 and mine are about 800 (both undetectable VL) so... from my perspective starting earlier is a pretty good thing.  Just my 2 cents for anyone in the 'starting soon' zone.
11/9/06 = #$%^&!
sometime early Dec 2006:
CD4 530 20%/VL >250,000 (&*$$%!!)
started Reyataz300mg/Norvir/Truvada 12-27-06.
1/30/07 CD4 540 30%/VL <400
4/07 CD4 600+ 33%/VL <50
6/9/07 CD4 720 37%/VL <50
10/15/07 CD4 891 (!) %? VL <50
1/2010 CD4 599 (37%) VL<50 (drop due to acute HCV)
9/2010 - looks like HCV is gone for good! And I'm finally drinking again, thank GOD
2013 - considering a switch to Stribild. but I love my Kidneys (but I hate farting all the time!)...
June 2013 - switched to Stribild.  so far so good...

 


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