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Poll

Is this a normal to wait ART for one month for economical issue?

CD4 under 200 ART now?
0 (0%)
Can I keep my health status for one month with Cd4 200?
0 (0%)

Total Members Voted: 0

Author Topic: Newly positive, not sure about the doctors' treatment  (Read 330 times)

zach and 1 Guest are viewing this topic.

Offline Aisukuriimu

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Newly positive, not sure about the doctors' treatment
« on: April 30, 2016, 09:05:45 AM »
Hey guys I'm newly positive here and I had some questions you might be able to answer and help me out ;)

My CD4 191, viral load 120000/ml, 24years old and no symptoms of HIV related disease developing yet. Although this blood test was only taken once.
Here in Japan somehow doctor's got to screen my CD4 twice (4weeks of time)in order to file a great insurance to cover ART treatment so he doesn't want to bring up CD4 by treating me with ART right away but instead, he is using PCP antibiotics until I get the second CD4 counted. Would it be possible that it might be too late waiting to take ART?

Thanks guys

Offline Wade

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Re: Newly positive, not sure about the doctors' treatment
« Reply #1 on: April 30, 2016, 09:18:39 AM »
Hi,
I'm sorry for you recent diagnosis and the trouble you are having .
I have no idea why your doctor wont start you on treatment with your numbers being what they are.   If it were me I would see a different doctor . 
Please keep us posted and Welcome to the forums.

Best, Wade
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Online zach

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Re: Newly positive, not sure about the doctors' treatment
« Reply #2 on: April 30, 2016, 10:52:47 AM »
if it's unavoidable, if a second test is required, wait 4 weeks to start meds

but it is NOT ideal, your CD4 is very low, you shouldn't wait much longer than that

it is never too late to start meds, but that's not reason enough to procrastinate


Online JimDublin

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Re: Newly positive, not sure about the doctors' treatment
« Reply #3 on: April 30, 2016, 10:54:54 AM »
Hi.

Welcome to the forum.
Not sure I understand why you need to wait to start treatment.
It's recommended to start treatment at diagnosis.

Anyhow welcome and I hope to hear more from you.

Jim
HIV 101 - Basics
HIV 101
You can read more about Transmission and Risks here:
HIV Transmission and Risks
You can read more about Testing here:
HIV Testing
You can read more about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read more about HIV prevention here:
HIV prevention
You can read more about PEP and PrEP here
PEP and PrEP

Offline CaveyUK

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Re: Newly positive, not sure about the doctors' treatment
« Reply #4 on: April 30, 2016, 10:58:33 AM »
Are you absolutely sure you have your facts correct regarding the wait being due to insurance?

What you may however find is that at <200 cells, the doctor may want to start you on co-trimoxazole (PCP antibiotics) and wait and make sure you are fine on these before starting ART. The reason for this is that some people get a reaction to the co-trimoxazole after a week or two of treatment. When I was diagnosed (cd4 was 160) I was given the co-trimoxazole (called Septrin in the UK) and had to wait a couple of weeks before starting HIV meds. The reason for this was simple - if I started both Septrin AND ART at the same time, it would be tough to figure out which meds were causing any side effect and by staggering them it would help ensure I am fine on the antibiotics before starting.

Admittedly 4 weeks seems like overkill but this could be the reason.

Another reason you may have to wait a short time is for genotype (restistance) tests to come back, if the preferred ART regimen contains abacavir (such as the Triumeq once-a-day pill) as hypersensitivity is not unheard of and this needs to be confirmed before starting.

Now you are on co-trimoxazole, have a cd4 count just under the 200 threshold and don't have any OI's you should be fine waiting for this period before commencing ART.

If there are any further delays beyond this point you need to find out why, because then it would be detrimental not to start treatment.
Diagnosed 29th Dec, after Home test 27th Dec 2015
29th Dec 2015 - CD4 160, VL 70,363, CD4% 16
Started Septrin 31st Dec & Tivicay/Truvada 12th Jan 2016
9th February 2016 - CD4 245, VL 96, CD4% 19
8th March 2016 - VL 61 (no CD4 taken)
5th April 2016 - CD4 354, VL <40, CD4% 22

Offline CaveyUK

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Re: Newly positive, not sure about the doctors' treatment
« Reply #5 on: April 30, 2016, 11:15:51 AM »
It's recommended to start treatment at diagnosis.

There are a number of scenario's where this would not be the case. I've mentioned a couple in my post, but also the management of certain co-infections come into the decision as well although I don't think they apply to the OP. (Such as management of HBV/HCV co-infection, TB etc).
« Last Edit: April 30, 2016, 11:18:35 AM by CaveyUK »
Diagnosed 29th Dec, after Home test 27th Dec 2015
29th Dec 2015 - CD4 160, VL 70,363, CD4% 16
Started Septrin 31st Dec & Tivicay/Truvada 12th Jan 2016
9th February 2016 - CD4 245, VL 96, CD4% 19
8th March 2016 - VL 61 (no CD4 taken)
5th April 2016 - CD4 354, VL <40, CD4% 22

Online JimDublin

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Re: Newly positive, not sure about the doctors' treatment
« Reply #6 on: April 30, 2016, 12:42:38 PM »
Generally speaking unless you have good reason otherwise, it remains recommended to start at or soon after diagnosis. So I stand by my post.

Hi.

Welcome to the forum.
Not sure I understand why you need to wait to start treatment.
It's recommended to start treatment at diagnosis.

Anyhow welcome and I hope to hear more from you.

Jim
HIV 101 - Basics
HIV 101
You can read more about Transmission and Risks here:
HIV Transmission and Risks
You can read more about Testing here:
HIV Testing
You can read more about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read more about HIV prevention here:
HIV prevention
You can read more about PEP and PrEP here
PEP and PrEP

Offline CaveyUK

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Re: Newly positive, not sure about the doctors' treatment
« Reply #7 on: Yesterday at 07:23:04 PM »
Generally speaking unless you have good reason otherwise, it remains recommended to start at or soon after diagnosis. So I stand by my post.

"or soon after" i agree with.

It is a really important distinction, as there may be valid reasons to wait a few weeks in order to start drugs like Triumeq (ie wait for genotype tests), begin prophylaxis or address certain co-infection issues. I wouldn't want anyone freaking out because they are not handed their pills moments after being told they are positive :)

4 weeks though, at this sort of CD4 level, is pretty much at the outer range of the time you would want to wait and I think any suggestion that someone continues longer than this without treatment would be folly and should be addressed with the doctor urgently. PCP prophylaxis mitigates immediate risk areas but getting prompt treatment is still paramount.

So to the OP, don't worry too much about the 4wks, but if I was in your shoes I would probably contact your clinical team to find out more about the preferred treatment and why exactly the wait has been recommended. I don't know Japanese insurance rules, but I can't see what value there would be about submitting any claim based on CD4 levels....The count indicates advanced HIV, and that is unlikely to change within the timeframe. Seeing two comparable CD4 tests to establish a trend would seem an odd guideline at < 200. Best of luck and keep us posted
« Last Edit: Yesterday at 07:34:46 PM by CaveyUK »
Diagnosed 29th Dec, after Home test 27th Dec 2015
29th Dec 2015 - CD4 160, VL 70,363, CD4% 16
Started Septrin 31st Dec & Tivicay/Truvada 12th Jan 2016
9th February 2016 - CD4 245, VL 96, CD4% 19
8th March 2016 - VL 61 (no CD4 taken)
5th April 2016 - CD4 354, VL <40, CD4% 22

Online JimDublin

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Re: Newly positive, not sure about the doctors' treatment
« Reply #8 on: Today at 12:37:45 AM »
Were simply not going to see eye to eye on this one Cavey.
Its simple recommend to start as soon as possible, delay for no valid reason is bad.

I did not see from the OP that genotype or anything medically treatment wise from the results are pending.

Jim
HIV 101 - Basics
HIV 101
You can read more about Transmission and Risks here:
HIV Transmission and Risks
You can read more about Testing here:
HIV Testing
You can read more about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read more about HIV prevention here:
HIV prevention
You can read more about PEP and PrEP here
PEP and PrEP

 


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