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Author Topic: bloodwork question  (Read 2029 times)

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Offline aferstilo

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bloodwork question
« on: February 02, 2009, 03:03:16 PM »
My current numbers are pretty good so my doctor said i should get bloodwork done every 6 months i told him that seemed like too far from each other and i wanted every 3 months what do you guys recommend?
1/13/09 CD4 1129/34.2% - VL 22,000
5/15/09 CD4 1300/33%   -  VL 35,000
11/17/09 CD4 659/ 23%  - VL 150,000
1/18/09  - STarted Atripla
2/18/10 Cd4 774- 30% - Vl 1,600
5/6/10   CD4 866 40% - VL Undetectable

Offline John2038

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Re: bloodwork question
« Reply #1 on: February 02, 2009, 04:26:58 PM »
Your current count have most probably inspired your Doc.
Now if you get only 1 bloodwork done since you know you are poz, I would probably want another bloodwork in 3 months, just to confirm it. Then I will enjoy getting a bloodwork every 6 months  :)

Offline aztecan

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Re: bloodwork question
« Reply #2 on: February 03, 2009, 12:04:41 AM »
If you're not on meds, the standard of care is to draw labs once a quarter (every three months).

The reason for this is to monitor the person to make sure he or she doesn't crash and burn without anyone knowing about it.

Also, if this was your first set of labs, you should be getting poked at least once every three months until some sort of pattern is demonstrated.

Your absolute CD4 is very good. Your percentage is pretty good and your viral load is OK. None of your numbers indicate any problems at this time.

But that is only one set of labs, so we cannot discern any pattern.

HUGS,

Mark

« Last Edit: February 03, 2009, 10:41:14 PM by aztecan »
"May your life preach more loudly than your lips."
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Offline Ann

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Re: bloodwork question
« Reply #3 on: February 03, 2009, 07:33:55 AM »
Hi aferstilo,

I totally agree that you should be having blood draws at least every three months. Like Mark says, you can't really have much of an idea where you're at with just one set of results. If your numbers stay as fantastic as they are after a couple years, then  you might  think about going twice a year. Even then, I would be dubious.

I'd also be questioning this doctor's judgement. Again, as Mark says, it's standard of care  to be checked quarterly when not on meds. It's not unheard of for a person to go from great numbers to not-so-great numbers in the space of a couple months.

Take care,
Ann
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Offline aferstilo

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Re: bloodwork question
« Reply #4 on: February 03, 2009, 11:03:51 AM »
Thank you guys so much  for your responses. this actually makes me think if my id doctor is the right one.. i will deff be getting bloodwork done every three months. again thanks.

Rick
1/13/09 CD4 1129/34.2% - VL 22,000
5/15/09 CD4 1300/33%   -  VL 35,000
11/17/09 CD4 659/ 23%  - VL 150,000
1/18/09  - STarted Atripla
2/18/10 Cd4 774- 30% - Vl 1,600
5/6/10   CD4 866 40% - VL Undetectable

Offline woodshere

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Re: bloodwork question
« Reply #5 on: February 03, 2009, 01:37:39 PM »
If you have a good relationship with this dr and after discussion you have your next draw in three months, then I am not sure I would find another.  If however, he insists you wait 6 mts, then by all means find another.  ALL healthcare decisions, regardless of one's illness, should be discussed between patient and dr with mutual respect and understanding.  My dr. recommended 4mth draws, however after my last blood work my CD4 dropped so we are back to 3 month draws until we see if this is a blip or something more.
"Let us give pubicity to HV/AIDS and not hide it..." "One of the things destroying people with AIDS is the stigma we attach to it."   Nelson Mandela

Offline John2038

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Re: bloodwork question
« Reply #6 on: February 03, 2009, 04:06:29 PM »
There is nothing wrong from this ID doc to want to do a bloodwork every 6 months with such high CD4/% and reasonnably low VL (after 2-3 stable bloodwork). Now most people and probably ID doc feel more better doing it every 3-4 months.

See the Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents - November 3, 2008

In particular the Table 3 p.13

John

Offline RapidRod

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Re: bloodwork question
« Reply #7 on: February 03, 2009, 04:34:47 PM »
aferstilo, after being a LTNP for 21 years and being tested every three months between blooddraws my CD4 crashed and I ended up in the hospital for a month with an OI. Being newly diagnosed and not on any meds I would not recommend going 6 months between visits. 

Offline Assurbanipal

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Re: bloodwork question
« Reply #8 on: February 03, 2009, 04:48:34 PM »
There is nothing wrong from this ID doc to want to do a bloodwork every 6 months with such high CD4/% and reasonnably low VL (after 2-3 stable bloodwork). Now most people and probably ID doc feel more better doing it every 3-4 months.

See the Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents - November 3, 2008

In particular the Table 3 p.13

John

John

The Table you cite is a summary table, which is probably intended primarily as an aide de memoire for doctors who have read through the full recommendations.  The actual recommendation on the following page clarifies that 3-4 month testing is standard of care at first, with 6 month testing an option after several years have passed with little change in results.

"Frequency of CD4 Count Monitoring. In general, CD4 counts should be determined every 3–4 months to (1) determine when to start antiretroviral therapy in patients not being treated; (2) assess immunologic response to antiretroviral therapy; and (3) assess the need for initiation or discontinuation of prophylaxis for opportunistic infections (AI). For those patients who are adherent to therapy with sustained viral suppression and stable clinical status for more than 2–3 years, the frequency of CD4 count monitoring may be extended to every 6 months (BIII)."

I'd stick with the 3 months for at least the first few years Aferstilo
A
5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

Offline John2038

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Re: bloodwork question
« Reply #9 on: February 04, 2009, 02:17:15 AM »
Assurbanipal

You are right. But again, with such high CD4s/% and quite low VL, many ID doc will recommend a monitoring every 6 months (if the counts seems stable). Only those with such high counts have been offered doing so.
For most of the others patients (vast majority), it's 3 months.

The guideline mention:

In general, CD4 counts should be determined every 3–4 months

But CD4 above 1000 in naive patients (not in acute infection) is not the general situation.
Maybe 30% of the HIV poz population in the first years post infection ?

And still, this guideline is mentioning 6 months. So for wich patient if not those like the one who started this thread ?

My point is not to be right, but to say that this ID doc is not necessarly wrong. It is also to say that I am not shocked by what have said this doc, and I would not shoot to him for that.

BTW I was followed up by a renowed ID doc in Europe.
She told me: If your percentage were a bit higher, I will monitor your counts every 6 months.
Now it will be every 3 months.


Personally, even with high CD4s/% and low VL, I would feel much better with a 3 months interval monitoring.
« Last Edit: February 04, 2009, 02:20:53 AM by John2038 »

Offline bocker3

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Re: bloodwork question
« Reply #10 on: February 04, 2009, 07:46:48 AM »
John -- stop interpreting the guideline and stop trying to justify what the doctor wants.  The doctor didn't ask for input here.  You are getting wrapped up in the wrong area here -- would YOU personally have been comfortable getting your labs done every 6 months pre-med?  I know that I would NOT have been.  There are too many incidents within our AM family of folks seeing dramatic changes in less than 6 months.
Personally, I would tell my doctor that, while I value his opinion, I need to be able to sleep at night and wish to have bloodwork every 3 months at this point.

Mike
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
Sep05 T=350/25% VL98,559
Nov05 288/18%  47,564
Current Labs
May2013 691/31% <20

Offline John2038

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Re: bloodwork question
« Reply #11 on: February 04, 2009, 03:46:16 PM »
bocker3, stop dictating your point of view.
You are free to express yours, I am free to express mine.

Offline bocker3

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Re: bloodwork question
« Reply #12 on: February 04, 2009, 06:57:24 PM »
bocker3, stop dictating your point of view.
You are free to express yours, I am free to express mine.
You are right -- I probably could have stated things a bit differently, but you aren't addressing the posters question.  You are getting caught up in whether the doctor is "right".  Whether he is "right" by the letter of the guideline is debatable, but everyone else seems to be agreeing that they would be uncomfortable going 6 months between labs.

Mike
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
Sep05 T=350/25% VL98,559
Nov05 288/18%  47,564
Current Labs
May2013 691/31% <20

Offline John2038

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Re: bloodwork question
« Reply #13 on: February 05, 2009, 12:52:02 PM »
bocker3

Let people express their point of view in the way they want to.
I am not the only one who is talking in this thread about the doc perspective, so you may want to talk to most the responders here. I am not expecting you to continue talking about that. So topic close for me.

Back to the 3/6 months debate. Most of the time, those monitored on a 3-4 months basis and having a bad lab will very probably do one or two others labs to ensure the counts they got is not related to any cold or whatever. That's for the

If the VL/CD4 are recommended for some to be made every 3-6 months, it doesn't means that if someone feel bad, he/she won't see her/his ID doc, who will decide which labs are appropriate to do.

But again, my point of view (and I am free to express it), is that for someone with such high counts, in good shape (assuming the others labs are also good, etc), being tested every 6 months seems perfectly reasonable.I mean in the real world in which we live, and despite my very personal preference who will to be monitored on a 3 months basis.

I finally guess that for the very vast majority of those having been monitored every 3 months, the decision to start meds haven't been taken the very next month that have followed a bad lab.
Because we need to see the trend of such variation, and confirm it. And loosing 3 months of HAART won't in most case kill the patient. Again, there are others labs to do than just the VL/CD4, and signal may be apparent there too.

John

Offline lonewolf

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Re: bloodwork question
« Reply #14 on: February 05, 2009, 01:01:22 PM »
Speaking from my own experience,   I think blood work is good every 3 months.  For a few reasons,  one just for that checkup to see if anything has changed,  it can.  Secondly for just your piece of mind,  waiting 6 months and speculating is not fun,  even waiting 3 months sometimes can stress you out.
And thirdly,  as you live on with HIV, you might experience other side effects with the virus that you will have questions and concerns with,  and having an appointment with your Dr at least every three months will give you the luxury to talk to him one on one.    By the way,   keep yourself a diary of ANYTHING that you feel is affecting your body and share with him.    Again the  joys of at least a visit every 3 months.     You will feel better in many ways.

Hugs,  Bruce
"To all within the sound of my voice, I appeal: Learn with me the lessons of history and of grace, so my children will not be afraid to say the word “AIDS” when I am gone. Then, their children and yours may not need to whisper it at all."  Mary Fisher

Offline aferstilo

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Re: bloodwork question
« Reply #15 on: February 06, 2009, 09:15:31 AM »
thanks alot for all your answers i talked to my doctor again and he said most people in my situation would be happy to only do it every 6 months but since i want every three months he'll do just that.


rick
1/13/09 CD4 1129/34.2% - VL 22,000
5/15/09 CD4 1300/33%   -  VL 35,000
11/17/09 CD4 659/ 23%  - VL 150,000
1/18/09  - STarted Atripla
2/18/10 Cd4 774- 30% - Vl 1,600
5/6/10   CD4 866 40% - VL Undetectable

 


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