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Author Topic: Are You Ditching Condoms?  (Read 785 times)

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Offline tednlou2

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Are You Ditching Condoms?
« on: July 24, 2016, 02:57:06 AM »
I've tried to keep up on the threads, so I hope I didn't miss a recent thread about this.  I did find a recent discussion about the no transmission studies in Research.

So, the Partner, Opposites Attract, and another study I can't remember the name all showed no transmissions, when someone is UD.  The studies couldn't say zero chance, but said it was likely zero.  Dr. Gallant tires of the transmission questions, when UD.  He was recently asked whether there's still the chance semen may not be UD and he said people who are UD in blood do not transmit the virus.  He also discussed a study, which said having an STI may not actually increase the risk of transmission. 

I started meds in January.  Been UD since at least April.  My partner and I decided to ditch condoms.  I still have that worry that I may infect him, especially if I top.  I see these studies, which say no transmissions were documented of thousands of partners and thousands of sex acts.  We know tops are at much less risk anyway.  But if I top and especially if ejaculating inside, I can't help but think there's all that semen entering a place which we know is the greatest vector of transmission.  I can't help thinking some virus may be there which can infect. 

But it seems barring failing a regimen and becoming detectable, that isn't going to happen.  Guess I'm curious how many believe that is the case and whether you've decided to ditch condoms with your consenting partner(s)?  I have heard some say to wait 2 years.  However, I've read docs like Gallant say UD is UD, whether 2 months or 2 years.  And he also says he thinks a neg partner in a monogamous relationship going on PrEP is an unnecessary expense, when his or her partner is UD.  Of course, he says if it gives them peace of mind, then he would certainly prescribe it.  I've had 100% adherence.  Condoms were an issue for us and got in the way of a "normal" sex life.  My partner already has some issues and wearing a condom made it almost impossible for him to stay erect.  He even got Viagra, but insurance won't cover it and 6 pills were over $300. 

Or, do you worry these studies may be giving us a false sense of security and it is just still too risky?

Offline JimDublin

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Re: Are You Ditching Condoms?
« Reply #1 on: July 24, 2016, 04:21:40 AM »
Quote
Are You Ditching Condoms?

Quote
Guess I'm curious how many believe that is the case and whether you've decided to ditch condoms with your consenting partner(s)? 

Me personally no.

My reasons are not HIV transmission related, i have very little to no concerns regarding that.

My main reasons are to protect myself against other STI's and the risk of fathering a 3rd child. 2 are more than enough. Now i know not everybody will have the same concerns i have. 

Not reading into headlines, the studies have provided much clarity on the subject of HIV transmission whilst successfully on treatment, however no study is ever going announce that there absolutely no risk of transmission even when they find no transmission during the studies.

That said i think you are worrying to much, if your partner is conformable with the knowledge and ditching condoms and so are you than that is great for you.

Jim
« Last Edit: July 24, 2016, 04:28:01 AM by JimDublin »
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Online leatherman

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Re: Are You Ditching Condoms?
« Reply #2 on: July 24, 2016, 07:45:28 AM »
I started meds in January.  Been UD since at least April.  My partner and I decided to ditch condoms.
looking at the PARTNER study, all the hetero couples had had their poz partner UD for 3 years, all the homosexual couples for UD for at least 2 years. The study has NOT released a result about how long someone needs to be UD before no transmission happen.

Y'all have not yet met the criteria for that study by being UD for 3 months, and there has been no data that says that 3 months is long enough.


tbh I have almost always used condoms with all my partners since I started having sex in 1981. I even still use condoms with my current poz partner. In seems every time I haven't used condoms during sex I've either gotten an STI or a UTI - neither which are any fun. So I don't take the risk. ;) plus I think condoms make the clean up afterwards a lot easier.
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Offline bocker3

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Re: Are You Ditching Condoms?
« Reply #3 on: July 24, 2016, 11:13:56 AM »
Ted,

At the end of the day, it doesn't matter what others are or are not doing in regards to condoms.  As you saw in Jim's post -- his reasons would not really be applicable to your case and, quite honestly, that is probably true for anyone.

This is a PERSONAL decision that each couple has to make.  If your partner is comfortable without condoms AND you are comfortable without condoms, then go for it.  If it either is uncomfortable, talk it through and reach a consensus on how to proceed.  Based on your post, you seem to have worries about topping him without a condom -- perhaps you can start by going condomless when he tops, but you put one one on when you top -- at least until you are comfortable.  Sex shouldn't cause stress -- it should relieve it!!!

Good luck --

Mike
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Online CaveyUK

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Re: Are You Ditching Condoms?
« Reply #4 on: July 24, 2016, 01:50:34 PM »
looking at the PARTNER study, all the hetero couples had had their poz partner UD for 3 years, all the homosexual couples for UD for at least 2 years. The study has NOT released a result about how long someone needs to be UD before no transmission happen.

It is hard to interpret the statistical aspects of the study in terms of baseline without having the raw data. It is true that all participants were already on ART and for some time beforehand however it is also true that at baseline, participants reported having condomless sex for a long time pre-study, some for as long as their partner had been on ART - more so for hetero couples than homosexual couples it has to be said.

The study didn't draw any conclusions based on this data, other than to say that couples who are virally suppressed on ART have reported zero transmissions. And by suppressed they mean fewer than 200 copies/mm.

Quote
Y'all have not yet met the criteria for that study by being UD for 3 months, and there has been no data that says that 3 months is long enough.

And there is no data to suggest it isn't either. With people even on fully suppressive ART experiencing blips along the way, I don't think there is a safe period of time to wait, other than some arbitrary periods sometimes quoted based on what 'feels' like common sense. The biggest issue with people who have just started ART is adherence... Someone who has been on ART for a year and stayed UD is clearly adherent. Someone who has been on ART for 3 months may not wind up being. I'd say this is more of a variable that plays into the couples risk decision rather than anything scientific though.

For what it's worth, I am on a similar timeline to tednlou2 and have decided to go condomless with my GF. This is actually at her request principally, she is aware of the very small 'theoretical' risk and is happy to proceed. She feels that the sheer number of time we had unprotected sex pre-diagnosis (many times) without transmission, coupled with my current UD status, makes the risk decision easier. I should add, for completeness, that we don't tend to have 'rough' sex, and invariably I don't finish during penetrative sex itself which *may* lower risk still further.  My doctor is aware of our intentions also.

If I were, hypothetically, to start a new relationship or have any other kind of sex, it would be with condoms. I feel strongly that it is a risk decision that only individuals can take when armed with the correct information and is not a catch-all. After all, many negative people still use condoms for a variety of reasons too.

Diagnosed 29th Dec, after Home test 27th Dec 2015
29th Dec 2015 - CD4 160, VL 70,363, CD4% 16
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Offline Lightfighter

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Re: Are You Ditching Condoms?
« Reply #5 on: July 24, 2016, 07:43:51 PM »
I'm in a similar place as you with my wife. We've discussed it and read the data. It's her decision and she seems on board with it when I'm UD.

She and I trust the data and the opinion of my ID doc and those like Dr Gallant.

Like everyone here has said; it's a personal choice that is unique to each couple.

Offline JimDublin

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Re: Are You Ditching Condoms?
« Reply #6 on: July 25, 2016, 01:22:39 AM »
To be honest, like everyone else here has said, it all down to personal choice and level of risk acceptance between partners. Like Mike pointed out my reasons are not applicable to everyone. Its a personal thing depending on situation and risk acceptance.

Now I have not had the time to read the partner studies results in depth yet ill admit.

Ill add that the past studies such as HPTN 052 were also highly successful however did have transmissions, 4 cases due to treatment failure despite taking meds.

Partner studies:
The study, led by Alison Rodger of University College London, said:


Although these results cannot directly provide an answer to the question of whether it is safe for serodifferent couples to practice condomless sex, this study provides informative data (especially for heterosexuals) for couples to base their personal acceptability of risk on.


An accompanying editorial in JAMA by Eric Daar and Katya Corado of the Harbor-UCLA Medical Center, warned that couples should not take the study to mean that their risk of transmission is zero.

They wrote:
For individuals who want to routinely or intermittently not use condoms with an HIV-infected partner, clinicians can indicate that the risk of HIV transmission appears small in the setting of continued viral suppression.

The HIV-positive partner should be using antiretrovirals for at least six months before the couple engages in condomless sex, they cautioned.

Moreover, clinicians need to be clear that even though the overall risk for HIV transmission may be small, the risk is not zero and the actual number is not known, especially for higher-risk groups such as MSM [men who have sex with men

They added that “more research is needed with larger numbers of couples and longer follow-up.”

http://www.thejournal.ie/hiv-antiretroviral-2876083-Jul2016/
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Offline tryingtostay

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Re: Are You Ditching Condoms?
« Reply #7 on: July 25, 2016, 03:52:56 AM »
absolutely not

Online CaveyUK

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Re: Are You Ditching Condoms?
« Reply #8 on: July 25, 2016, 01:20:39 PM »

They added that “more research is needed with larger numbers of couples and longer follow-up.”

http://www.thejournal.ie/hiv-antiretroviral-2876083-Jul2016/

Problem is though, that it will never be zero. Ever. Even with more studies, due to the statistical confidence range. Even with condoms the risk is never zero, of course.

The people who contracted HIV during the study were proven to have been infected outside their current relationship (via genotyping).

The longer someone is on ART the better due to more likely adherence, that much is true.

At the end of the day, it really is a discussion between individuals and understanding of risks involved. As you say, everyone is different :)
Diagnosed 29th Dec, after Home test 27th Dec 2015
29th Dec 2015 - CD4 160, VL 70,363, CD4% 16
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Online leatherman

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Re: Are You Ditching Condoms?
« Reply #9 on: July 25, 2016, 01:48:15 PM »
having had a partner who waited too long too test, my remaining advice/opinion would be to make sure to have your negative partner checked regularly. you know, just in case.

While I certainly believe that a certain time length of remaining undetectable does make the risk of transmission to be so low as to be nearly zero, I believe the science also shows, in a worst case scenario, that starting ARVs as soon as possible after being infection will result in long-term lifelong benefits of less damage by HIV and better health.
leatherman (aka mIkIE)

All the stars are flashing high above the sea
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We're gonna burn this disco down before the morning comes
- Pet Shop Boys

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Online CaveyUK

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Re: Are You Ditching Condoms?
« Reply #10 on: July 25, 2016, 01:55:48 PM »
having had a partner who waited too long too test, my remaining advice/opinion would be to make sure to have your negative partner checked regularly. you know, just in case.

While I certainly believe that a certain time length of remaining undetectable does make the risk of transmission to be so low as to be nearly zero, I believe the science also shows, in a worst case scenario, that starting ARVs as soon as possible after being infection will result in long-term lifelong benefits of less damage by HIV and better health.

Totally agreed. My GF has agreed to regular tests also (thats a no-brainer, even without the TAsP question)
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  - UD (<40), CD4% 22
5th July 2016 - VL - UD (<40) (no CD4 taken)

Offline TheNormalLife

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Re: Are You Ditching Condoms?
« Reply #11 on: July 25, 2016, 03:15:24 PM »
Me and my partner's (neg) choice is no (have only been UD since exactly a year ago).

If we are talking about monogamous intercourse it could be safe to ditch them only if we meet the criteria of the HIV-related studies.

I agree in the fact that this is a personal choice, however STDs (let's keep HIV out of the equation for now) are a universal problem more than a personal issue especially if we are in the dating scene. There are a whole bunch of other STDs out there and none in their right mind wants to deal with them. This is especially true for us who live with HIV; no matter how good our numbers are our immune system is compromised because of our little dormant (or latent) guest. We surely do not want to run excessive risks or over demand our system as it is already fighting 24/7 the damn bug.

Ray.
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Offline JimDublin

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Re: Are You Ditching Condoms?
« Reply #12 on: July 25, 2016, 03:30:43 PM »
Problem is though, that it will never be zero. Ever. Even with more studies, due to the statistical confidence range. Even with condoms the risk is never zero, of course.

Oh but i fully agree, but i don't see it as a problem.
Better studies will reinforce the results so far and that's a good thing.

no study is ever going announce that there absolutely no risk of transmission even when they find no transmission during the studies.


The people who contracted HIV during the study were proven to have been infected outside their current relationship (via genotyping).

Well in the HPTN 052 i mentioned it clearly states that in the end report (IAS 2015):
four of these eight cases were diagnosed soon after ART initiation and transmission likely occurred before the HIV-infected partner was virally suppressed. The other four were diagnosed when the HIV-infected partner had detectable levels of virus in the blood despite being on ART (treatment failure). Treatment failure may have occurred because participants either did not take their antiretroviral drugs as prescribed or had an HIV strain that resisted or acquired resistance to one or more of the drugs in their treatment regimen.
https://www.hptn.org/research/studies/33

Jim
« Last Edit: July 25, 2016, 03:37:15 PM by JimDublin »
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Offline tednlou2

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Re: Are You Ditching Condoms?
« Reply #13 on: July 25, 2016, 06:13:55 PM »
It is certainly still anxiety-producing right now.  I'm not talking not being able to sleep or anything, but just some concern still.  Like I said before and not to be graphic (but it's necessary to discuss), if I top and especially if ejaculating inside, I can't help but wonder there's some virus there able to infect in a place we know is the best vector of transmission.  I've been getting my viral load checked every 2 months so far.  I believe it's only after 2 years that viral load testing is recommended to be moved to 6 months.  Once viral suppressed, I believe it is 3-4 months, until suppressed for 2 years. 

So despite 100% adherence, I will know whether I was failing a regimen much sooner.  But I believe it is rare to fail a regimen for reasons other than poor adherence.  But, yes, it happens.  We do see people with blips.  I think I've seen some here discuss a blip to 1,000+, but then return to UD.  Am I remembering that correctly?  Or, were those people failing their regimen?  And if not failing, are those blips real and not lab errors?  It spiked for whatever reason and that level (especially over 200) could result in transmission?  We know the vagina is already a better barrier to infection and many study participants were heterosexual.  But, there were many homosexual as well. 

On a side note, it will be interesting to see how these studies affect criminalization.

Online CaveyUK

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Re: Are You Ditching Condoms?
« Reply #14 on: July 26, 2016, 04:12:53 PM »
Oh but i fully agree, but i don't see it as a problem.
Better studies will reinforce the results so far and that's a good thing.

Well in the HPTN 052 i mentioned it clearly states that in the end report (IAS 2015):
four of these eight cases were diagnosed soon after ART initiation and transmission likely occurred before the HIV-infected partner was virally suppressed. The other four were diagnosed when the HIV-infected partner had detectable levels of virus in the blood despite being on ART (treatment failure). Treatment failure may have occurred because participants either did not take their antiretroviral drugs as prescribed or had an HIV strain that resisted or acquired resistance to one or more of the drugs in their treatment regimen.
https://www.hptn.org/research/studies/33

Jim

Sorry Jim, yes - I was referring to PARTNER. The study you mentioned did have some failures, but I don't see an inconsistency really. In those cases the HIV+ partner wasn't UD, due to either treatment failure or sex before reaching UD status. This is one of the reasons why adherence is so important and why it is worth waiting a while once UD to ensure everything is good on that front, especially if there could be any doubt on that front.
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  - UD (<40), CD4% 22
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Online CaveyUK

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Re: Are You Ditching Condoms?
« Reply #15 on: July 26, 2016, 04:30:50 PM »
I've been getting my viral load checked every 2 months so far.  I believe it's only after 2 years that viral load testing is recommended to be moved to 6 months.  Once viral suppressed, I believe it is 3-4 months, until suppressed for 2 years. 

It varies based on location, what recommendations are followed and seems to be something that is constantly changing.

For example, I've been told that after being on meds for a year - assuming I'm stable, it will move to 6 monthly. I suspect much will have to do with funding (certainly in the UK, which is all free at point of access) as well as adherence-risk profile etc.

Quote
So despite 100% adherence, I will know whether I was failing a regimen much sooner.  But I believe it is rare to fail a regimen for reasons other than poor adherence.  But, yes, it happens.  We do see people with blips.  I think I've seen some here discuss a blip to 1,000+, but then return to UD.  Am I remembering that correctly?  Or, were those people failing their regimen?  And if not failing, are those blips real and not lab errors?  It spiked for whatever reason and that level (especially over 200) could result in transmission?  We know the vagina is already a better barrier to infection and many study participants were heterosexual.  But, there were many homosexual as well. 

Most 'blips' will be less than 200. Occasionally more - but often it seems this comes hand-in-hand with some other transient illness (I've already discussed with my GF that if I have flu or something else, we will be extra careful). Lab errors are not unheard of.

We cannot say with 100% certainty, as with everything, but different drugs/combos have different resistance profiles and the newest drugs on the market such as Dolutegravir have especially good profiles in various studies, so it is less likely people will suddenly develop drug resistance than they may have done in days gone by.

It reminds me a bit about the smoking vs vaping debate. Everyone agrees that not doing either is best for you, but I heard it described by an eminent French doctor as 'Vaping is like driving at 90mph on the motorway (freeway for you yanks!). Smoking is like driving 90mph the wrong way on the motorway!'.... This is similar....complete abstinence or increased methods of protection are the safest bet. TAsP without condoms is a risk, but a low one. Condomless sex whilst not adherent to effective treatment is hideously dangerous.

We can live our lives in the most riskless, sanitised way if we choose, or we can make informed decisions based on mitigation strategies which don't remove the risk but make the option more palatable.

We all take (non HIV) risks every day. We drive too fast, pick arguments with the wrong people, eat less than healthy food, self-medicate for various things and so on. We all have different tolerances for risk and thats what makes us human. Thankfully, with the latest studies here we now have options where years ago it was unthinkable.

Quote
On a side note, it will be interesting to see how these studies affect criminalization.

Yup, although I suspect many of the places with these draconian laws have ingrained prejudices towards folk with HIV, so I don't expect anything to change soon, sadly. Hope I'm wrong.
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  - UD (<40), CD4% 22
5th July 2016 - VL - UD (<40) (no CD4 taken)

Online leatherman

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Re: Are You Ditching Condoms?
« Reply #16 on: July 26, 2016, 04:47:55 PM »
interestingly POZ just posted an article dealing with this subject

Does Undetectable Mean Uninfectious? The Challenge of Explaining HIV Study Results
https://www.poz.com/article/undetectable-mean-uninfectious-challenge-explaining-hiv-study-results

Quote
The cautionary words in the PARTNER press release and editorial such as “appears small,” “may be small” and “risk is not zero” greatly understate and minimize the significance of the study. Word choices like “negligible,” “effectively zero risk” or even “extremely small” would be more accurate and meaningful and have been used by other experts to describe this PARTNER’s result.
 
We could easily veer into a discussion over semantics and how people interpret specific words that convey risk—after all, there isn’t one agreed-upon measurement of risk—but I take it you believe the tone of the press release is intentionally cautionary?
Even when they agree with the force of evidence from real-world and clinical trial experience, medical and public health professionals have been reluctant to communicate the significance and meaning of it because of two primary concerns:
 
An increase in condomless sex among people with HIV who are undetectable will lead to an increase in STIs; and

People with HIV might not understand that staying on treatment is essential to maintain an undetectable viral load. For instance, they might interrupt treatment by personal choice or due to circumstances outside of their control and unknowingly experience an increase in viral load and risk of HIV transmission.
Many AIDS service organizations and community-based groups and medical providers selectively choose to discuss the science with patients and clients whom they judge are “responsible” (for example: monogamous and with a stable linkage to treatment) rather than directly address the impacts of risk compensation and disinhibition through education and access.
leatherman (aka mIkIE)

All the stars are flashing high above the sea
and the party is on fire around you and me
We're gonna burn this disco down before the morning comes
- Pet Shop Boys

chart from 1992-2015
Isentress/Prezcobix

Online leatherman

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Re: Are You Ditching Condoms?
« Reply #17 on: July 26, 2016, 07:47:41 PM »
It varies based on location, what recommendations are followed and seems to be something that is constantly changing.
Ted was referencing the CDC guidelines that I have referenced in other threads about cd4 testing

so it is less likely people will suddenly develop drug resistance than they may have done in days gone by.
yeppers. old days vs new days.

and it's why LTSes, as defined now i.e. pre-haart, will always be different no matter how long other people may end up living with HIV. Many people just don't understand how "lucky" they are to have been diagnosed in or after the early 2000s. the landscape surrounding HIV treatment and care has been a constantly improving situation for the last 35 years.  treatment now is so much less of a guessing game and improvements continue to be brought to market. While many of the meds may have similar side effects as they did in the past (lipo, bone density, etc), the re-formulated/co-formulated current version of the meds have shown those side effects affect much fewer people. Drug resistance these days is nearly always a case of improper or non-adherence.
leatherman (aka mIkIE)

All the stars are flashing high above the sea
and the party is on fire around you and me
We're gonna burn this disco down before the morning comes
- Pet Shop Boys

chart from 1992-2015
Isentress/Prezcobix

Offline tednlou2

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Re: Are You Ditching Condoms?
« Reply #18 on: Yesterday at 02:57:33 PM »
Ted was referencing the CDC guidelines that I have referenced in other threads about cd4 testing
yeppers. old days vs new days.

Not just CD4 testing, right?  The guidelines are to move viral load to 6 months+, only after UD for 2 years??  It should be done 4-8 weeks, until UD.  after that, it is every 3-4 months, until you reach 2 years??

Online leatherman

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Re: Are You Ditching Condoms?
« Reply #19 on: Yesterday at 03:59:58 PM »
Quote
After 2 years of ART, VL consistently suppressed and CD4 consistently 300-500:
Time between viral load test can extend to every 6 months for patients with consistent viral suppression for >=2 years.
With the cd4 test done every 12 months

After 2 years of ART, VL consistently suppressed and CD4 consistently >500 cells/mm3:
the CD4 test is Optional
https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/458/plasma-hiv-1-rna--viral-load--and-cd4-count-monitoring
"Table 4. Recommendations on the Indications and Frequency of Viral Load and CD4 Count Monitoring"
http://hiv.ucsf.edu/docs/hiv_monitoring_guideline.pdf
"Table. Summary of HIV-specific routine laboratory monitoring" (pg 5)
leatherman (aka mIkIE)

All the stars are flashing high above the sea
and the party is on fire around you and me
We're gonna burn this disco down before the morning comes
- Pet Shop Boys

chart from 1992-2015
Isentress/Prezcobix

Offline xunil

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Re: Are You Ditching Condoms?
« Reply #20 on: Yesterday at 10:33:01 PM »
It is interesting looking at the table that it says in patients who are stable on ART that if the last CD4 was >500 to not repeat the CD4 count.  Wouldn't they want to check it at least every once in a while to make sure there isn't a problem?
Diagnosed April 2015
First labs and specialist visit April 2015
Initial appt and labs: CD4 560 and VL 18,000
Started Triumeq June 2015
VL UD after 30 days on Triumeq, CD4 slowly rising.

Online leatherman

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Re: Are You Ditching Condoms?
« Reply #21 on: Today at 06:23:59 AM »
Wouldn't they want to check it at least every once in a while to make sure there isn't a problem?
nope. the Viral load test, by a serious rise, would show if there is a problem. (not just a "micro-blip" or "blip")

the reason why the cd4 is just less reliable as a treatment tool is because:

1. it's highly variable by up to 100 points with a single day
2. everyone's baseline "normal" cd4 is different and can be in the huge range of 400 - 1500
3. the cd4 count is not a measurement of "healthiness"; it is only the amount of cd4s present. there is no way to measure the strength of a person's cd4s. It's just assumed that more cd4s should make a person healthier because there is a high number of cd4s to do the work; however some people with low cd4s (say the low 300 range) can be quite healthy while others with a high cd4 count (above 1000) can be quite sickly (not with OIs but with other health issues)
4. the only cd4 count that matters is whether a person's cd4 is above or below 200 because that is the point at which OIs can possibly happen
5. currently there is no way to improve the cd4 count. all we can do is take antiretrovirals to suppress the HIV allowing a person's cd4s to increase to whatever level they might rise to dependent on the damage done by the HIV before treatment and the genetics passed to each of us by our parents.

leatherman (aka mIkIE)

All the stars are flashing high above the sea
and the party is on fire around you and me
We're gonna burn this disco down before the morning comes
- Pet Shop Boys

chart from 1992-2015
Isentress/Prezcobix

 


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