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Author Topic: To Sue or Not  (Read 11177 times)

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Offline tednlou2

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To Sue or Not
« on: January 26, 2010, 09:57:36 PM »
I've mentioned several times how I was given 4 days of Atripla in the hospital without my knowlege.  I found out, because they also outed my status.  A nurse came in and said what meds she was giving me.  My brother and his partner who are a chiropractor and OBGYN doc knew what the drug was for.  They asked me why I was being given HIV meds--I hadn't told them I was poz. 

Since then, I've learned it was very irresponsible to start HIV meds with no plan to continue them.  I also learned that Atripla is the one med I'm resistant to now.  Everyone who knows my status keeps telling me I should sue the hospital for this--not to mention outing me.  I say the hospital just made a mistake and didn't mean to do harm.  I feel like I would be creating bad karma to sue.  I got better from the pneumonia after all. 

They reply saying hospitals are in it for profit and companies won't change unless they have to pay out money.  They say if they cut my leg off, I would sue without question.  They say they have forever taken Atripla out of my treatment options and it may come down that I may have needed that option.  I say I'm not even on meds yet and who knows whether I would need Atripla.  And, with a history of depression and anxiety, I may have not done well on it.  Plus, sueing would create more stress probably.  And, I could have been resistant to Atripla to begin with.  However, many HIV experts have told me it was probably the hospital that caused the resistance.  They said Atripla has a low genetic barrier or something like that and is one of the easiest drugs to get resistant.

So, I'm just wondering what you guys think.  Am I being "too naive and a push-over"?  Should I just be thankful I got better and let it go as a mistake?  Or, are they right that hospitals are corporations now and only respond to lawsuits to make changes?  By the way, it would probably hard to sue anyway.  Often, you have to show how you have been affected right now by the mistake.  They would argue I'm not on meds yet and I have other options.   

Offline Fondoo

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Re: To Sue or Not
« Reply #1 on: January 26, 2010, 10:25:42 PM »
 I say forget about it and focus on being peaceful and happy.

Offline Nestor

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Re: To Sue or Not
« Reply #2 on: January 26, 2010, 10:27:18 PM »
Unless there's something I'm not taking into consideration, that's a pretty big mistake: the first thing everybody knows about HIV meds is that you can't start taking them and then just stop.  For the hospital to have done that is outrageous.  And what point would there be of giving Atripla just for four days and then stopping?  

But a few questions here: 1. Did they give you a choice before they started giving you Atripla?  2. Did they inform you before you starting taking it or after?  3. Did they recommend that you continue after the four days?  3b. What kind of numbers did you have at that time? (I ask this because, if you had shockingly low t-cells, giving you atripla might have been the right thing, but then they should have recommended that you continue it.  4. What kind of condition were you in in general at that time?  

I'm usually against suing; at least once in my life I've been wronged so horribly that I thought, and all of my friends thought, that I could and should sue.  I didn't because I thought the whole process would bring more negative energy into my life than any possible benefit could be worth.  But in this case it isn't just about you; it's about making sure this kind of thing doesn't happen again to other people.  
Summer 2004--became HIV+
Dec. 2005--found out

Date          CD4    %       VL
Jan. '06    725    25      9,097
Nov. '06    671    34     52,202
Apr. '07    553    30      24,270
Sept. '07  685    27       4,849
Jan. '08    825    29       4,749
Mar. '08    751    30     16,026
Aug. '08    653    30       3,108
Oct. '08     819    28     10,046
Jan '09      547    31     13,000
May '09     645   25        6,478
Aug. '09    688   30      19,571
Nov. '09     641    27       9,598
Feb. '10     638    27       4,480
May '10      687      9    799,000 (CMV)
July '10      600     21      31,000
Nov '10      682     24     15,000
June '11     563    23     210,000 (blasto)
July  '11      530    22      39,000
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Sept. '12    747     15      14,000

Offline Inchlingblue

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Re: To Sue or Not
« Reply #3 on: January 26, 2010, 10:39:03 PM »
This is the kind of situation that if it's presented right by the right lawyer, they would likely make an offer to settle.

No matter what, it's negligent for them to have given you Atripla for 4 days with no intention of informing you so that you would stay on it or go off it correctly.

Because the meds in Atripla have different half lives, it's easy to become resistant to Sustiva if you just go off it like that. The way to go off it properly is to continue just the Truvada for a certain number of days and even then there are no guarantees there will be no resistance.

HIV meds are not ever to be prescribed for just  a few days, even PEP is prescribed for 28 days minimum.

Nothing wrong if you decide to sue, just don't let it get to you emotionally etc. Only do it if you can approach it in a calm rational manner. And, yes, it's important to point this out so that it does not happen to other people.
« Last Edit: January 27, 2010, 09:42:58 AM by Inchlingblue »

Offline GNYC09

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Re: To Sue or Not
« Reply #4 on: January 26, 2010, 10:45:08 PM »
I would sue if you're now resistant to one or more of the drugs in Atripla due to the hospital's actions.  That said, I've never heard of a stress-free lawsuit.  Be prepared for that.
I wish you good luck.
« Last Edit: January 26, 2010, 10:54:01 PM by GNYC09 »

Offline Hellraiser

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Re: To Sue or Not
« Reply #5 on: January 26, 2010, 10:52:53 PM »
If they didn't educate you about the hiv infection and the atripla they were at fault for your strain now being resistant to that medicine.  The doctor who was attending to you at the hospital should have explained that you were positive and they placed you on atripla which if you stop taking can cause the virus to become resistant to it.  They should have known better than to do what they did.

Offline skeebo1969

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Re: To Sue or Not
« Reply #6 on: January 26, 2010, 11:07:04 PM »


   Would 4 days be enough to become resistant if you suddenly stopped?  I was under the impression that resistance came about by missing doses repeatedly, thus allowing your strain to mutate.  Is it the same if you stop the Atripla immediately?  Not disputing your situation at all, I just would like to be corrected if my thinking is wrong.  I wonder if that would be the hospital's argument as well.  Did they do a genotype test before they administered the Atripla?  If you don't know you can go to the hospital and for a minimum fee get your records on exactly what they did.

   If you go to an ASO perhaps they can advise you of a lawyer who is familiar with some of the factors concerning HIV treatment.  If not, the pessimist in me, I would think they might just turn you down. Definitely do your research and if you get turned down by one lawyer it doesn't mean you don't necessarily have a case.

I despise the song Love is in the Air, you should too.

Offline leatherman

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Re: To Sue or Not
« Reply #7 on: January 26, 2010, 11:11:35 PM »
Did you already have an ID doc?
did your hospital refer you to an ID doc?
Did an ID doc see you while you in the hospital?

It sounds you, or your representative, was told they were administering Atripla to you (you state this in your story). It would have been up to you to continue medication after leaving the hospital.
 
(ps I would wait to sue until you find out if you've got a cold or having pnuemonia again before suing the hospital . LOL)
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline Dennis

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Re: To Sue or Not
« Reply #8 on: January 26, 2010, 11:19:36 PM »

   Would 4 days be enough to become resistant if you suddenly stopped?  I was under the impression that resistance came about by missing doses repeatedly, thus allowing your strain to mutate.  Is it the same if you stop the Atripla immediately?  

I have heard the same thing from my doc. I had to go without my meds for short period and was worried about resistance. He told me as long as I stopped all meds at once resistance wouldn't be an issue. Luckily, he was right. I'm on Norvir, Truvada, and Reyataz. Would the resistance issue be different with Atripla?

Offline Hellraiser

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Re: To Sue or Not
« Reply #9 on: January 26, 2010, 11:22:29 PM »
I'm no expert but as I understand it:  when you go on the medication it prevents the virus from replicating.  When you get off of the medicine the virus has now been exposed to it and mutates into a form that the medication is not effective against.  I'm not sure why the quantity or the time frame would matter.  Anyone able to illuminate the issue for us?

Offline chguy78

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Re: To Sue or Not
« Reply #10 on: January 26, 2010, 11:36:51 PM »
To prove negligence you need to show a duty, a breach of that duty, causation and damages.  Causation could be difficult to prove because there are sustiva-resistant strains out there (I have one) and without that genotype beforehand, a jury could find that it's more likely than not that you had one and it wasn't caused by the drugs being administered to you for that short amount of time. 

Then there are the damages.  What monetary damages have you incurred if the jury does find causation? Are all treatments unavailable to you now?  Probably not.  There are many treatments out there just as good as Atripla, right?  Maybe not as cheap since you'll have to buy two or three prescriptions each month now.  But remember, it's about money.  It sucks that you can't take Atripla - but were you monetarily damaged.  Some states have the punitive damages tied directly to compensatory damages, too, so without that you can't get the punitive damages.  Pain and suffering is sometimes just limited to physical and not mental anguish.  Just depends.

Regarding the breach of confidentiality.  I have no idea.

It never hurts to talk to an attorney in your state, though.  A lot have free consultations for this type of case.
01/11: CD4=753 (36%), VL=Undetectable
07/10: CD4=531 (33%), VL=Undetectable
04/10: CD4=746 (33%), VL=Undetectable
01/10: CD4=566 (35%), VL=Undetectable
10/09: CD4=436 (31%), VL=405
07/09: CD4=631 (27%), VL=847
06/09: Started: Truvada, Reyataz, Norvir
05/09: CD4=426 (28%), VL=38,300
04/09: Positive; CD4=466 (28%), VL=39,700
10/08: Negative

Offline Miss Philicia

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Re: To Sue or Not
« Reply #11 on: January 27, 2010, 12:00:23 AM »
To prove negligence you need to show a duty, a breach of that duty, causation and damages.  Causation could be difficult to prove because there are sustiva-resistant strains out there (I have one) and without that genotype beforehand, a jury could find that it's more likely than not that you had one and it wasn't caused by the drugs being administered to you for that short amount of time. 

exactly
"Iíve slept with enough men to know that Iím not gay"

Offline Inchlingblue

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Re: To Sue or Not
« Reply #12 on: January 27, 2010, 12:05:02 AM »
I have heard the same thing from my doc. I had to go without my meds for short period and was worried about resistance. He told me as long as I stopped all meds at once resistance wouldn't be an issue. Luckily, he was right. I'm on Norvir, Truvada, and Reyataz. Would the resistance issue be different with Atripla?

Yes it's different with Atripla, as explained in my post above.

What Skeebo is saying is something else at any rate. He is saying that maybe being on Atripla for only four days is not enough time to then become resistant if you stop. I'm pretty sure that 4 days is enough for resistance to develop if one were to stop, especially if the person has a viral load as opposed to being undetectable.

It would be good to find out if they did a resistance test. It would seem to me that the point of the lawsuit is that even if it cannot be proven definitively that his Sustiva resistance is due to the fact that they gave him Atripla for four days, it is still negligent to give someone Atripla for just 4 days while they are in the hospital, this is not the way any ARV medication is supposed to be prescribed. They were negligent in the way they prescribed it and it very likely caused the resistance.
« Last Edit: January 27, 2010, 09:27:32 AM by Inchlingblue »

Offline leatherman

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Re: To Sue or Not
« Reply #13 on: January 27, 2010, 12:15:39 AM »
I'm not sure why the quantity or the time frame would matter.
there are no hard and fast rules about resistance. Resistance usually doesn't occur until someone drops below 90-85% compliant*. It all depends on how much virus is free-floating in your system along with what level of meds. Resistance is caused when there is a lowered level of meds in your system which only kills a part of the virus in your system, while the rest of the viral load is able to mutate to not be affected by the med. Missing a dose here or there does not cause resistance most of the time; neither does only takes meds for a few days and then going completely off.


* More info
http://www.aidsmeds.com/articles/Resistance_7509.shtml

http://jac.oxfordjournals.org/cgi/content/abstract/53/5/696
Resistance to single protease inhibitor therapy occurs most frequently at moderate to high levels of adherence, resistance to non-nucleoside reverse transcriptase inhibitor therapy occurs at low to moderate levels of adherence, and resistance to ritonavir-boosted protease inhibitor therapy is most likely to occur at middle ranges of adherence

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495121/
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline leatherman

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Re: To Sue or Not
« Reply #14 on: January 27, 2010, 12:20:50 AM »
it is still negligent to give someone Atripla for just 4 days while they are in the hospital, this is not the way that medication is supposed to be prescribed. They were negligent in the way they prescribed it and it very likely caused the resistance.
a hospital will usually start you on HIV meds (especially based on high VL and low cd4 counts) to help lower your viral load and boost your immune system to prevent death while the hospital treats the immediate health issue. You always have the choice to take or not take meds in the hospital. It is up to the patient to obtain a doctor upon leaving the hospital to continue the treatment that the patient agreed to in the hospital.
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline madbrain

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Re: To Sue or Not
« Reply #15 on: January 27, 2010, 12:22:55 AM »
Did they do a genotype test before they administered the Atripla?  If you don't know you can go to the hospital and for a minimum fee get your records on exactly what they did.

I'm going to guess that they didn't, the genotype test takes a long time to get back, and this was an emergency case. Prescribing HAART was probably the right thing. Not informing the patient about the need to continue was wrong. It may or may not have caused the resistance.


Offline Dennis

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Re: To Sue or Not
« Reply #16 on: January 27, 2010, 12:47:55 AM »
When you were released from the hospital you should have been given a release form to sign. This form/s should have outlined any actions to take upon being released, such as a follow up with an HIV specialist, prescriptions to take, etc.

If your release form advised you to follow up with a doctor for HIV, I would imagine this would be fairly difficult to fight.

Offline Inchlingblue

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Re: To Sue or Not
« Reply #17 on: January 27, 2010, 09:29:43 AM »
a hospital will usually start you on HIV meds (especially based on high VL and low cd4 counts) to help lower your viral load and boost your immune system to prevent death while the hospital treats the immediate health issue. You always have the choice to take or not take meds in the hospital. It is up to the patient to obtain a doctor upon leaving the hospital to continue the treatment that the patient agreed to in the hospital.

If they gave him Atripla for 4 days, as he is saying, and they did not inform him that it must be continued without fail, then they did not prescribe it properly.

When you were released from the hospital you should have been given a release form to sign. This form/s should have outlined any actions to take upon being released, such as a follow up with an HIV specialist, prescriptions to take, etc.

If your release form advised you to follow up with a doctor for HIV, I would imagine this would be fairly difficult to fight.

They would have had to make it clear that Atripla must be continued without missing any doses. They can't just give someone Atripla for 4 days and not make it perfectly clear to them that they must continue. You just do not prescribe Atripla for 4 days, it's not the way that medication is supposed to be prescribed. Even if they said to follow up with an HIV doctor, that would not be enough as far as avoiding possible resistance to Sustiva.

It seems the hospital is not aware of the particular situation with Atripla and resistance if it is stopped incorrectly, there are other cocktails where this would not be as much of an issue, with Atripla it is.

There is a member here who had to go off it, and his doctor prescribed just the Truvada for about a week. This was done to avoid resistance since, as mentioned above, the drugs in Atripla have varying half-lives. This is what causes the resistance. If you stop Atripla, the Sustiva remains in your system longer once the Truvada has worn off, so it's like taking Sustiva by itself which is not enough for suppression and can likely lead to resistance. This is something the hospital should know, they might continue to do this with other people and it is wrong, plain and simple.
« Last Edit: January 27, 2010, 09:43:22 AM by Inchlingblue »

Offline RapidRod

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Re: To Sue or Not
« Reply #18 on: January 27, 2010, 10:42:13 AM »
If they gave him Atripla for 4 days, as he is saying, and they did not inform him that it must be continued without fail, then they did not prescribe it properly.

They would have had to make it clear that Atripla must be continued without missing any doses. They can't just give someone Atripla for 4 days and not make it perfectly clear to them that they must continue. You just do not prescribe Atripla for 4 days, it's not the way that medication is supposed to be prescribed. Even if they said to follow up with an HIV doctor, that would not be enough as far as avoiding possible resistance to Sustiva.

It seems the hospital is not aware of the particular situation with Atripla and resistance if it is stopped incorrectly, there are other cocktails where this would not be as much of an issue, with Atripla it is.

There is a member here who had to go off it, and his doctor prescribed just the Truvada for about a week. This was done to avoid resistance since, as mentioned above, the drugs in Atripla have varying half-lives. This is what causes the resistance. If you stop Atripla, the Sustiva remains in your system longer once the Truvada has worn off, so it's like taking Sustiva by itself which is not enough for suppression and can likely lead to resistance. This is something the hospital should know, they might continue to do this with other people and it is wrong, plain and simple.
If his discharge paper says follow up with your doctor and he doesn't, that is his negligence.

Offline Inchlingblue

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Re: To Sue or Not
« Reply #19 on: January 27, 2010, 10:45:12 AM »
If his discharge paper says follow up with your doctor and he doesn't, that is his negligence.

There is a proper way to stop Atripla once you have started (especially if you have a viral load), and it entails continuing with Truvada for a certain number of days. They would have had to make that clear above and beyond saying to follow up with a doctor. They would have had to give him a Rx for Atripla or for a week's worth of Truvada.

A person can make an appointment to follow up with a doctor and that could take several days or even longer. This is not a matter of only following up with a doctor but rather of not missing even a single dose of a medication that they started him on, especially since he was not yet undetectable. It's two different things.
« Last Edit: January 27, 2010, 03:14:35 PM by Inchlingblue »

Offline Nashvegas

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Re: To Sue or Not
« Reply #20 on: January 27, 2010, 11:13:22 AM »
With a history of depression and anxiety, I certainly would not want to take Atripla (or, more specifically, Sustiva), and no doctor worth his salt should, in this day and age, prescribe Atripla for someone with that medical history.  From reading your original post, it also seems to me that you, personally, are NOT hell-bent on pursuing a lawsuit, and it's others who are pressuring you to do so.  Under the circumstances, I say let it go and move on.  You've got better ways to spend your time than pursuing a lawsuit in which it would be difficult to prove damages.  I'm a lawyer, and I wouldn't take on your case.   And, even if you found a lawyer willing to take on the case, most hospitals would NOT quickly roll over on this one and pay you a big fat settlement, in my experience.  Which means that you'd be in for an extended period of high anxiety and stress.  It just ain't worth it, in my opinion...   
8/12/06 - sero-conversion
9/14/06 -- Positive Test results confirmed
9/21/06 -- CD4 - 586; viral load 8,000; 29%
12/25/06 -- CD4 - 373; VL 2,800; 23%
2/10/07 - CD4 - 228; VL 865; 25%
3/15/07 -  CD4 - 365 (no viral load test)
5/1/07 = CD4 - 341; VL 4,358; 27%
8/1/07 - CD4 - 315; VL - 2,300; 25%
9/20/07 - CD4 - 378
11/22/07 - CD4 - 257; VL 7,300;
2/27/08 - CD4 231 (16.5 %), VL 5,960
5/20/08 - CD4 229 (18.3%), VL 11,100
6/17/08 - CD4 166 (14.5%), VL 9,030
6/17/08 - STARTED VIRAMUNE + TRUVADA
7/2/08 - CD4 272 (20%), VL 113  :-)
7/16/08 - CD4 -217 (21.1 %), VL - Undetectable
7/30/08 - CD4 - 220 (20.4%). VL - 92
8/14/08 - CD4 - 280 (22%) VL-undetectable
1/04/09 - CD4 - 250 (28%) VL-UD
5/15/09 - CD4 -393 (28%) VL-UD
8/15/09 - CD4-346, (26%) VL-UD
11/15/09 - CD4-373 (28%)

Offline RapidRod

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Re: To Sue or Not
« Reply #21 on: January 27, 2010, 11:14:12 AM »
Atripla doses cannot be missed, they would have had to make that clear above and beyond saying to follow up with a doctor. A person can make an appointment to follow up with a doctor and that could take several days or even longer. This is not a matter of only following up with a doctor but rather of not missing even a single dose of a medication that they started him on. It's two different things.
Now how does that put the resposibility on the hospital if he can't get into his doctor? That is not the hospitals problem.

Offline leatherman

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Re: To Sue or Not
« Reply #22 on: January 27, 2010, 11:35:18 AM »
Atripla doses cannot be missed
do u happen to have some link to a report that specifically discusses missing doses of atripla? instead of the reports about general adherence issues

no doctor worth his salt should, in this day and age, prescribe Atripla for someone with that medical history. 
I think you'll find that most hospitals do start anyone who presents with serious HIV/AIDS with Atripla, as it is a once-a-day front-line medication for treatment naive patients. I'm not saying that they shouldn't take other issues into consideration (ie mental issues etc); however the hospital is not the best option to have treating your HIV either. As with many issues in the hospital, it's about cost-effectiveness and time-management. Atripla costs less, uses less storage space, and takes less time of the staff to administer.
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline Nashvegas

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Re: To Sue or Not
« Reply #23 on: January 27, 2010, 11:54:10 AM »
I think you'll find that most hospitals do start anyone who presents with serious HIV/AIDS with Atripla, as it is a once-a-day front-line medication for treatment naive patients. I'm not saying that they shouldn't take other issues into consideration (ie mental issues etc); however the hospital is not the best option to have treating your HIV either. As with many issues in the hospital, it's about cost-effectiveness and time-management. Atripla costs less, uses less storage space, and takes less time of the staff to administer.

Understood.  My point is that, losing the ability to take Atripla is not necessarily much of a loss for someone who would not normally be prescribed Atripla by their personal physician in any event.  It goes to whether the original poster can establish any damages for his inability to take Atripla. 
8/12/06 - sero-conversion
9/14/06 -- Positive Test results confirmed
9/21/06 -- CD4 - 586; viral load 8,000; 29%
12/25/06 -- CD4 - 373; VL 2,800; 23%
2/10/07 - CD4 - 228; VL 865; 25%
3/15/07 -  CD4 - 365 (no viral load test)
5/1/07 = CD4 - 341; VL 4,358; 27%
8/1/07 - CD4 - 315; VL - 2,300; 25%
9/20/07 - CD4 - 378
11/22/07 - CD4 - 257; VL 7,300;
2/27/08 - CD4 231 (16.5 %), VL 5,960
5/20/08 - CD4 229 (18.3%), VL 11,100
6/17/08 - CD4 166 (14.5%), VL 9,030
6/17/08 - STARTED VIRAMUNE + TRUVADA
7/2/08 - CD4 272 (20%), VL 113  :-)
7/16/08 - CD4 -217 (21.1 %), VL - Undetectable
7/30/08 - CD4 - 220 (20.4%). VL - 92
8/14/08 - CD4 - 280 (22%) VL-undetectable
1/04/09 - CD4 - 250 (28%) VL-UD
5/15/09 - CD4 -393 (28%) VL-UD
8/15/09 - CD4-346, (26%) VL-UD
11/15/09 - CD4-373 (28%)

Offline Inchlingblue

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Re: To Sue or Not
« Reply #24 on: January 27, 2010, 12:12:42 PM »
Now how does that put the resposibility on the hospital if he can't get into his doctor? That is not the hospitals problem.

That's not what I wrote. You misread it.

Offline Inchlingblue

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Re: To Sue or Not
« Reply #25 on: January 27, 2010, 12:23:09 PM »
do u happen to have some link to a report that specifically discusses missing doses of atripla? instead of the reports about general adherence issues
I think you'll find that most hospitals do start anyone who presents with serious HIV/AIDS with Atripla, as it is a once-a-day front-line medication for treatment naive patients. I'm not saying that they shouldn't take other issues into consideration (ie mental issues etc); however the hospital is not the best option to have treating your HIV either. As with many issues in the hospital, it's about cost-effectiveness and time-management. Atripla costs less, uses less storage space, and takes less time of the staff to administer.

I'm not talking about missing doses of Atripla. This is not a case of missing doses of Atripla. In fact there was a FOTO study that determined Atripla can be taken "Five Days On Two Days Off."

This is not about "missing" a dose or two. It's about starting Atripla and then stopping it. There is a difference. I already explained it above, so it's tiring to repeat it, it has to do with the fact that the drugs in Atripla have varying half-lives.

As mentioned above, one of the members here, buffaloboy, stopped Atripla and his doctor kept him on just the Truvada for about a week, this was done in order to minimize chances of becoming resistant to Sustiva.

If you stop 3 medications that have the same or very similar half lives then they are all out of your system at about the same time and that's fine, not likely to develop resistance.

With Atripla, the half life of Sustiva is longer than those of the two drugs in Truvada so if you just stop taking Atripla, the Truvada wears off sooner and you still have Sustiva in your system by itself for a period of time and this is when resistance can develop, it's comparable to taking Sustiva monotherapy.

Stopping effective HIV treatment usually leads to fairly quick (2 weeks) rebound in virus and dropping CD4 count. That can lead to a variety of symptoms in some patients (possibly muscle pain) as well as risk for resistance in case of Atripla. I recommend seeing your HIV specialist for an evaluation and see if you can go to a clinic with ADAP/Ryan White funding to see if you qualify for drug assistance. KH

LINK:

http://www.thebody.com/Forums/AIDS/SideEffects/Current/Q199190.html

Stopping Atripla runs the risk of developing resistance particularly to the efavirenz with its long half life (persistence in blood). The risk for both AIDS and non-AIDS HIV related events (such as heart disease and cancer) increases after stopping HIV medication. I would suggest trying to discuss with a case manager at a Ryan White site nearby to examine your insurance/funding options. The ideal way to stop Atripla still needs to be determined but some experts recommend taking a boosted PI for several weeks after stopping as one approach. KH

LINK:

http://www.thebody.com/Forums/AIDS/SideEffects/Archive/Treatment/Q193745.html


If the hospital put him on Atripla it was their responsibility to inform him about this, not just give a general instruction to "follow up with your doctor," which is not enough in this particular case.
« Last Edit: January 27, 2010, 12:32:29 PM by Inchlingblue »

Offline RapidRod

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Re: To Sue or Not
« Reply #26 on: January 27, 2010, 12:24:36 PM »
That's not what I wrote. You misread it.
Your information is incorrect. I was taken off Atripla for a month because of incompatibility with my other medications and then I was put back on Atripla and it didn't cause an issue.

Offline Inchlingblue

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Re: To Sue or Not
« Reply #27 on: January 27, 2010, 12:28:50 PM »
Your information is incorrect. I was taken off Atripla for a month because of incompatibility with my other medications and then I was put back on Atripla and it didn't cause an issue.

My information is not incorrect, please read above, with links from thebody.com.

Resistance does not always happen, you were lucky. Also, whether a person has a viral load or not is a factor. If a person is undetectable when they stop then there is less of a chance of resistance.
« Last Edit: January 27, 2010, 12:33:46 PM by Inchlingblue »

Offline RapidRod

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Re: To Sue or Not
« Reply #28 on: January 27, 2010, 12:36:51 PM »
I'm not talking about missing doses of Atripla. This is not a case of missing doses of Atripla. In fact there was a FOTO study that determined Atripla can be taken "Five Days On Two Days Off."

This is not about "missing" a dose or two. It's about starting Atripla and then stopping it. There is a difference. I already explained it above, so it's tiring to repeat it, it has to do with the fact that the drugs in Atripla have varying half-lives.

As mentioned above, one of the members here, buffaloboy, stopped Atripla and his doctor kept him on just the Truvada for about a week, this was done in order to minimize chances of becoming resistant to Sustiva.

If you stop 3 medications that have the same or very similar half lives then they are all out of your system at about the same time and that's fine, not likely to develop resistance.

With Atripla, the half life of Sustiva is longer than those of the two drugs in Truvada so if you just stop taking Atripla, the Truvada wears off sooner and you still have Sustiva in your system by itself for a period of time and this is when resistance can develop, it's comparable to taking Sustiva monotherapy.

Stopping effective HIV treatment usually leads to fairly quick (2 weeks) rebound in virus and dropping CD4 count. That can lead to a variety of symptoms in some patients (possibly muscle pain) as well as risk for resistance in case of Atripla. I recommend seeing your HIV specialist for an evaluation and see if you can go to a clinic with ADAP/Ryan White funding to see if you qualify for drug assistance. KH

LINK:

http://www.thebody.com/Forums/AIDS/SideEffects/Current/Q199190.html

Stopping Atripla runs the risk of developing resistance particularly to the efavirenz with its long half life (persistence in blood). The risk for both AIDS and non-AIDS HIV related events (such as heart disease and cancer) increases after stopping HIV medication. I would suggest trying to discuss with a case manager at a Ryan White site nearby to examine your insurance/funding options. The ideal way to stop Atripla still needs to be determined but some experts recommend taking a boosted PI for several weeks after stopping as one approach. KH

LINK:

http://www.thebody.com/Forums/AIDS/SideEffects/Archive/Treatment/Q193745.html


If the hospital put him on Atripla it was their responsibility to inform him about this, not just give a general instruction to "follow up with your doctor," which is not enough in this particular case.

Give me a break. You going to blame a hospital for someone that doesn't take their medications correctly? The orginal poster doesn't have a suit.

Offline Hellraiser

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Re: To Sue or Not
« Reply #29 on: January 27, 2010, 12:42:45 PM »
It's not that he didn't take their medication correctly.

They didn't inform him that stopping the medication could potentially cause the virus to become resistant.
They didn't inform him that he should make a doctor's visit asap with an ID in order to continue Atripla.
They didn't give him any Atripla or a prescrption in order to continue taking it once he left the hospital.

I don't know whether it's suit worthy, but I'd sure as hell wanna have a word with the doctor who took away one of my treatment options.

Offline Inchlingblue

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Re: To Sue or Not
« Reply #30 on: January 27, 2010, 12:43:26 PM »
Give me a break. You going to blame a hospital for someone that doesn't take their medications correctly? The orginal poster doesn't have a suit.

If they explained it to him, then maybe you are right. But if they were not absolutely clear that he needs to continue Atripla without stopping once he leaves the hospital (and, as Hellraiser mentioned, give him a prescription for it) then it would seem he does have a case.

At any rate, I'm not a lawyer, are you? His best bet is to talk to a lawyer who is familiar with medical malpractice and with HIV in particular and they can advise him.

In any lawsuit you have to prove "loss" and his "loss" here is that he cannot ever take Sustiva or many other NNRTIs. This is not a major loss but it is a loss nonetheless and a price tag can be placed on that loss.
« Last Edit: January 27, 2010, 03:41:27 PM by Inchlingblue »

Offline John2038

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Re: To Sue or Not
« Reply #31 on: January 27, 2010, 12:49:17 PM »
I also learned that Atripla is the one med I'm resistant to now.

Was the blood draw for the genotype made before you started Atripla ? Was it made by the same hospital ?

A 4 day prescription is common in the EU for a PEP in the 48h following a risk exposure, typically by an MD at the emergency unit . Before the end of this 4 days regimen, the "patient" have to see a virologist in order to decide whether or not the PEP should be continued until the day 28, or changed (side effects, labs) or discontinued if after a reevaluation of the risk it appears to be too low to justify continuing a PEP.

I am wondering so if you haven't get prescribed a PEP.

Best Wishes

John


Offline Miss Philicia

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Re: To Sue or Not
« Reply #32 on: January 27, 2010, 12:49:28 PM »
The bottom line here is that tednlou2 has a rather acute case of anxiety disorder, one that seems to pre-date his HIV diagnosis and which has, understandably, worsened greatly post-diagnosis.  Yet it seems we have a cadre of lawsuit cheerleaders-in-residence that wish for this guy to ramp up his state of already acute stress and anxiety with what would inevitably be more of the same.  The only people here who seem to recognize this are tednlou2 himself in his opening post, and NashVegas.

This is a support group, not a debating society. I don't see how it's supportive to encourage a board member to engage in something that will only worsen his mental health.
« Last Edit: January 27, 2010, 12:51:00 PM by Miss Philicia »
"Iíve slept with enough men to know that Iím not gay"

Offline David_CA

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Re: To Sue or Not
« Reply #33 on: January 27, 2010, 01:00:51 PM »
I say forget about it and focus on being peaceful and happy.

I think you'll find that most hospitals do start anyone who presents with serious HIV/AIDS with Atripla, as it is a once-a-day front-line medication for treatment naive patients. I'm not saying that they shouldn't take other issues into consideration (ie mental issues etc); however the hospital is not the best option to have treating your HIV either. As with many issues in the hospital, it's about cost-effectiveness and time-management. Atripla costs less, uses less storage space, and takes less time of the staff to administer.

I was in the hospital for 8 days a little over 3 years ago with a nasty case of PCP pneumonia.  I had not started meds yet.  The second day I was there, I started Atripla.  It was actually the 3 base drugs in Atripla, but it's the same thing.  Nobody asked me about psychological issues, etc.  I'd had genotype and phenotype tests when I was first diagnosed (about 8 months prior) with no resistance, but I don't know if that was relayed to the hospital.  

First, the goal was to make me well.  If I had mental issues that would contraindicate Atripla, I would have been switched to another med after release from the hospital.  Upon release, I was given Rx's for Atripla and Bactrim.  There was nobody to hold my hand for either drug.  Had I not taken Atripla, I would likely have had more HIV-related illnesses.  If I didn't take the Bactrim, I think I would have PCP again.  

Bottom line, the hospital did what was required to help make me well.  After I was discharged, it was up to me.  I could have discussed meds with my ID Dr and changed them or continue like I did.  As to being outed, did you ask the nurse what the meds were or did she just blurt it out?  Either way, I wouldn't pursue any sort of legal proceedings.  

If I were in your position and felt strongly enough about it, I would contact the nurse or his/her supervisor and tell why I didn't like how it was handled.  It's done and over with; I say move on.  From some of your other posts, it sounds like you're not quite through the acceptance stage of diagnosis yet.  The sooner you get past that point, the better off you'll be.  Take care.
Black Friday 03-03-2006
03-23-06 CD4 359 @27.4% VL 75,938
06-01-06 CD4 462 @24.3% VL > 100,000
08-15-06 CD4 388 @22.8% VL >  "
10-21-06 CD4 285 @21.9% VL >  "
  Atripla started 12-01-2006
01-08-07 CD4 429 @26.8% VL 1872!
05-08-07 CD4 478 @28.1% VL 740
08-03-07 CD4 509 @31.8% VL 370
11-06-07 CD4 570 @30.0% VL 140
02-21-08 CD4 648 @32.4% VL 600
05-19-08 CD4 695 @33.1% VL < 48 undetectable!
08-21-08 CD4 725 @34.5%
11-11-08 CD4 672 @39.5%
02-11-09 CD4 773 @36.8%
05-11-09 CD4 615 @36.2%
08-19-09 CD4 770 @38.5%
11-19-09 CD4 944 @33.7%
02-17-10 CD4 678 @39.9%  
06-03-10 CD4 768 @34.9%
09-21-10 CD4 685 @40.3%
01-10-11 CD4 908 @36.3%
05-23-11 CD4 846 @36.8% VL 80
02-13-12 CD4 911 @41.4% VL<20
You must be the change you want to see in the world.  Mahatma Gandhi

Offline Inchlingblue

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Re: To Sue or Not
« Reply #34 on: January 27, 2010, 01:00:58 PM »
The bottom line here is that tednlou2 has a rather acute case of anxiety disorder, one that seems to pre-date his HIV diagnosis and which has, understandably, worsened greatly post-diagnosis.  Yet it seems we have a cadre of lawsuit cheerleaders-in-residence that wish for this guy to ramp up his state of already acute stress and anxiety with what would inevitably be more of the same.  The only people here who seem to recognize this are tednlou2 himself in his opening post, and NashVegas.

This is a support group, not a debating society. I don't see how it's supportive to encourage a board member to engage in something that will only worsen his mental health.

I'm not endorsing that he sue one way or the other but I do think it's important to see that the hospital acted wrongly here (based on the information supplied on this thread). They should be made aware so that this does not continue to happen to others.

  Upon release, I was given Rx's for Atripla and Bactrim.   

That's the important difference here: he was apparently not given an Rx for Atripla upon discharge, after they had given him 4 days worth while he was there.
« Last Edit: January 27, 2010, 01:03:56 PM by Inchlingblue »

Offline Hellraiser

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Re: To Sue or Not
« Reply #35 on: January 27, 2010, 01:05:47 PM »
I'm not endorsing that he sue one way or the other but I do think it's important to see that the hospital acted wrongly here (based on the information supplied on this thread). They should be made aware so that this does not continue to happen to others.

I'm not going to get involved with anymore finger pointing and I'll bow out of this thread, however I agree with Inchling on this.  I felt that it was wrong (not necessarily that he should sue) of them to not "finish what they started".  However, when I got out of the hospital I was so drugged up on painkillers I have no idea what they told me.  I'm pretty sure that even though they were suspicious of HIV however they gave me no HIV specific medications only anti-biotics.  If they had denied me the use of a treatment option, I would've been very upset about it.

Offline David_CA

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Re: To Sue or Not
« Reply #36 on: January 27, 2010, 01:10:11 PM »
I also learned that Atripla is the one med I'm resistant to now. 

I doubt you're resistant to all three drugs in Atripla.  I have 'partial' sensitivity to one of the components (or however it's worded), but that partial sensitivity plus maximal sensitivity to the other two makes it work for me.  I'm not saying you should take Atripla or not (by itself or with another drug); one would have to look at geno- and phenotype test results, taking any psychological issues into consideration, before making such a determination.  From what I've read about the drugs in Atripla, the hospital most likely did not cause any resistance.
Black Friday 03-03-2006
03-23-06 CD4 359 @27.4% VL 75,938
06-01-06 CD4 462 @24.3% VL > 100,000
08-15-06 CD4 388 @22.8% VL >  "
10-21-06 CD4 285 @21.9% VL >  "
  Atripla started 12-01-2006
01-08-07 CD4 429 @26.8% VL 1872!
05-08-07 CD4 478 @28.1% VL 740
08-03-07 CD4 509 @31.8% VL 370
11-06-07 CD4 570 @30.0% VL 140
02-21-08 CD4 648 @32.4% VL 600
05-19-08 CD4 695 @33.1% VL < 48 undetectable!
08-21-08 CD4 725 @34.5%
11-11-08 CD4 672 @39.5%
02-11-09 CD4 773 @36.8%
05-11-09 CD4 615 @36.2%
08-19-09 CD4 770 @38.5%
11-19-09 CD4 944 @33.7%
02-17-10 CD4 678 @39.9%  
06-03-10 CD4 768 @34.9%
09-21-10 CD4 685 @40.3%
01-10-11 CD4 908 @36.3%
05-23-11 CD4 846 @36.8% VL 80
02-13-12 CD4 911 @41.4% VL<20
You must be the change you want to see in the world.  Mahatma Gandhi

Offline GSOgymrat

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Re: To Sue or Not
« Reply #37 on: January 27, 2010, 01:36:20 PM »
I'm not trying to place blame here but I'm confused how the nurses gave you Atripla without your knowledge. The doctors and nurses are supposed to inform you of diagnosis and treatment as part of your rights as a patient. If they didn't do that they didn't do their job. I wouldn't sue in your situation because I just don't think it would be worth it however I would want to know why appropriate procedures were not followed.

Offline skeebo1969

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Re: To Sue or Not
« Reply #38 on: January 27, 2010, 01:48:58 PM »
  I am certain this won't be drawn out like the OJ trial if he does try to pursue it.   I  think  trying to prove liability would be extremely difficult.  He may have already been resistant to it to begin with.  A lawyer would do all the legwork and we are not talking about a murder trial here.  From reading this thread, like myself, it seems a lot of  people here have an aversion to the word sue.  It congers up visions of the lady who purposely slips in the store and sues because the tile was too glossy.  With that said though I do agree, Tednlou should concentrate on self right now.  Ted, you hang in there bud..
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Offline Miss Philicia

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Re: To Sue or Not
« Reply #39 on: January 27, 2010, 01:50:10 PM »
Also, in terms of the "outing" I'm somewhat confused.  You reference "My brother and his partner" as opposed to his wife or girlfriend -- are you saying that your brother is gay?  You've stated previously that you yourself have a partner and he didn't leave your hospital room the entire time, so staff would have known you are gay.  If your brother came into the hospital, signed in with his gay partner, and presented himself as such to hospital staff, I'd assume it was a reasonable assumption to make that there were not secrets to be had in the room.
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Offline Dennis

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Re: To Sue or Not
« Reply #40 on: January 27, 2010, 01:56:31 PM »
On top of a patient's rights, a patient also has responsbilities. A couple of those responsibilities include providing accurate and complete information of their medical history as well as providing written consent or refusal to treatment and procedures requested by the treating physycian.

When I was in for PCP i was urged to take meds for HIV. I refused and also had sign a paper stating so.

In addition to hospital release papers, did the op also receive and sign a copy of the the hospitals and patients rights and responsibilites at the time of admission?


Offline chguy78

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Re: To Sue or Not
« Reply #41 on: January 27, 2010, 02:35:28 PM »
Also, in terms of the "outing" I'm somewhat confused. 

I took the "outing" as referring to his testing positive for HIV not for his sexual orientation.
01/11: CD4=753 (36%), VL=Undetectable
07/10: CD4=531 (33%), VL=Undetectable
04/10: CD4=746 (33%), VL=Undetectable
01/10: CD4=566 (35%), VL=Undetectable
10/09: CD4=436 (31%), VL=405
07/09: CD4=631 (27%), VL=847
06/09: Started: Truvada, Reyataz, Norvir
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Offline Inchlingblue

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Re: To Sue or Not
« Reply #42 on: January 27, 2010, 02:51:20 PM »
   Causation could be difficult to prove because there are sustiva-resistant strains out there (I have one) and without that genotype beforehand, a jury could find that it's more likely than not that you had one and it wasn't caused by the drugs being administered to you for that short amount of time. 

 I am certain this won't be drawn out like the OJ trial if he does try to pursue it.   I  think  trying to prove liability would be extremely difficult.  He may have already been resistant to it to begin with.  

The thing is he responded very well when they gave him Atripla for 4 days, with his viral load going down and CD4s shooting way up, which would indicate that he was not resistant to begin with.

I doubt you're resistant to all three drugs in Atripla.  

I think when he says he is resistant to Atripla he means he is resistant to Sustiva (Efavirenz); he has mentioned this in another post. Being resistant to Sustiva also means he is resistant to other drugs in that class, NNRTIs.
« Last Edit: January 27, 2010, 03:08:48 PM by Inchlingblue »

Offline skeebo1969

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Re: To Sue or Not
« Reply #43 on: January 27, 2010, 02:57:13 PM »
The thing is he responded very well, with his viral load going down and CD4s shooting way up, which would indicate that he was not resistant to begin with.

Hmmm, that is something I definitely overlooked here.  Damn that is a real bitch then.. something that would definitely have me talking to an attorney.
I despise the song Love is in the Air, you should too.

Offline David_CA

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Re: To Sue or Not
« Reply #44 on: January 27, 2010, 04:12:25 PM »
The thing is he responded very well when they gave him Atripla for 4 days, with his viral load going down and CD4s shooting way up, which would indicate that he was not resistant to begin with.

I think when he says he is resistant to Atripla he means he is resistant to Sustiva (Efavirenz); he has mentioned this in another post. Being resistant to Sustiva also means he is resistant to other drugs in that class, NNRTIs.

Not necessarily.  Look at my numbers... especially when I started meds.  My VL dropped and my CD4's increased.  I have some resistance to one of the meds in Atripla (I can't remember which; I'll have to look it up at home), but still my numbers improved.  Remember, it wasn't all that long ago that monotherapy was the norm; it also worked for a while before resistance became an issue.  If being on meds for 4 days and then stopping caused resistance, wouldn't almost everybody that ever stopped a particular drug be resistant to that drug? 

According to my ID Dr, there's also something, and I can't remember what it's called, either, where the wild type virus is suppressed by meds causing an intial drop in VL.  Once suppressed, other 'forms' of the virus increase due to not being resistant to the meds.  I'll have to try and find more specifics.  At any rate, it would be hard to believe and prove that 4 days of Atripla caused resistance.  Isn't this one of the reasons for both a genotype and phenotype.  http://hivdb.stanford.edu/pages/documentPage/genoPheno.html

Black Friday 03-03-2006
03-23-06 CD4 359 @27.4% VL 75,938
06-01-06 CD4 462 @24.3% VL > 100,000
08-15-06 CD4 388 @22.8% VL >  "
10-21-06 CD4 285 @21.9% VL >  "
  Atripla started 12-01-2006
01-08-07 CD4 429 @26.8% VL 1872!
05-08-07 CD4 478 @28.1% VL 740
08-03-07 CD4 509 @31.8% VL 370
11-06-07 CD4 570 @30.0% VL 140
02-21-08 CD4 648 @32.4% VL 600
05-19-08 CD4 695 @33.1% VL < 48 undetectable!
08-21-08 CD4 725 @34.5%
11-11-08 CD4 672 @39.5%
02-11-09 CD4 773 @36.8%
05-11-09 CD4 615 @36.2%
08-19-09 CD4 770 @38.5%
11-19-09 CD4 944 @33.7%
02-17-10 CD4 678 @39.9%  
06-03-10 CD4 768 @34.9%
09-21-10 CD4 685 @40.3%
01-10-11 CD4 908 @36.3%
05-23-11 CD4 846 @36.8% VL 80
02-13-12 CD4 911 @41.4% VL<20
You must be the change you want to see in the world.  Mahatma Gandhi

Offline RapidRod

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Re: To Sue or Not
« Reply #45 on: January 27, 2010, 04:41:53 PM »
If that were even true, nPEP for 28 days would sure screw up a lot of people.  Which we know is not the case.

Offline David_CA

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Re: To Sue or Not
« Reply #46 on: January 27, 2010, 04:50:14 PM »
If that were even true, nPEP for 28 days would sure screw up a lot of people.  Which we know is not the case.
Duh, good point; I kinda forgot about that! 
Black Friday 03-03-2006
03-23-06 CD4 359 @27.4% VL 75,938
06-01-06 CD4 462 @24.3% VL > 100,000
08-15-06 CD4 388 @22.8% VL >  "
10-21-06 CD4 285 @21.9% VL >  "
  Atripla started 12-01-2006
01-08-07 CD4 429 @26.8% VL 1872!
05-08-07 CD4 478 @28.1% VL 740
08-03-07 CD4 509 @31.8% VL 370
11-06-07 CD4 570 @30.0% VL 140
02-21-08 CD4 648 @32.4% VL 600
05-19-08 CD4 695 @33.1% VL < 48 undetectable!
08-21-08 CD4 725 @34.5%
11-11-08 CD4 672 @39.5%
02-11-09 CD4 773 @36.8%
05-11-09 CD4 615 @36.2%
08-19-09 CD4 770 @38.5%
11-19-09 CD4 944 @33.7%
02-17-10 CD4 678 @39.9%  
06-03-10 CD4 768 @34.9%
09-21-10 CD4 685 @40.3%
01-10-11 CD4 908 @36.3%
05-23-11 CD4 846 @36.8% VL 80
02-13-12 CD4 911 @41.4% VL<20
You must be the change you want to see in the world.  Mahatma Gandhi

Offline Assurbanipal

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Re: To Sue or Not
« Reply #47 on: January 27, 2010, 04:59:46 PM »
Ted

It sounds like you are under a lot of pressure, which you really don't need. 

It might help to break it into pieces.

Are you resistant to all of Atripla (unlikely) or just the Sustiva part? 

If it is just Sustiva, with your history, you are probably not a good candidate to take it anyway.  And as one of the other posters pointed out, it will be difficult for you to show that you were harmed by becoming resistant to a drug that you shouldn't take anyway.

If you are under a lot of pressure from your family and friends though it might make sense for you to talk to your ASO and see if they could refer you to a lawyer so you get an "official" response as to whether you have a case -- seems unlikely though.

But sometimes getting an official answer that something won't work is the easiest way to get it off the list of things to worry about.

Hope you get over the cold soon -- have some chicken soup :-)

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 Inchlingblue

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Re: To Sue or Not
« Reply #48 on: January 27, 2010, 06:24:17 PM »
Not necessarily.  Look at my numbers... especially when I started meds.  My VL dropped and my CD4's increased.  I have some resistance to one of the meds in Atripla (I can't remember which; I'll have to look it up at home), but still my numbers improved.  Remember, it wasn't all that long ago that monotherapy was the norm; it also worked for a while before resistance became an issue.  If being on meds for 4 days and then stopping caused resistance, wouldn't almost everybody that ever stopped a particular drug be resistant to that drug?  

According to my ID Dr, there's also something, and I can't remember what it's called, either, where the wild type virus is suppressed by meds causing an intial drop in VL.  Once suppressed, other 'forms' of the virus increase due to not being resistant to the meds.  I'll have to try and find more specifics.  At any rate, it would be hard to believe and prove that 4 days of Atripla caused resistance.  Isn't this one of the reasons for both a genotype and phenotype.  http://hivdb.stanford.edu/pages/documentPage/genoPheno.html

If that were even true, nPEP for 28 days would sure screw up a lot of people.  Which we know is not the case.

Duh, good point; I kinda forgot about that!  

Atripla stopping protocol

Joel E. Gallant, M.D., M.P.H.

Question:

Posted on Dec 30, 2009
Hi Dr. Gallant, A friend of mine, treatment naive, started atripla a couple of weeks ago. However, he got a rash all over his body and, 11 days after having started meds,   his hiv doctor told him to stop atripla altogether and to come back for a new combo in 1 month. I was under the impression that in the case of having to stop an efavirenz based combo it was recommended either to immediately start the new combo or at least continue with the nrti backbone of the treatment for a couple of weeks in order to avoid being in an efavirenz effective monotherapy, due to its long half-life, with the corresponding risk of developing resistance to it. I told my friend to consult that aspect with his doctor, but have yet to hear from him about it, and wanted to confirm whether my concerns were well founded. Thanks a lot and happy new year!

Response:

On Dec 30, 2009 Joel E. Gallant, M.D., M.P.H. replied:
This is not how I'd do it. It's very clear that stopping Atripla can result in NNRTI resistance, especially if the viral load is not suppressed at the time of interruption.

The first thing to remember is that it's rarely necessary to stop efavirenz because of a rash, which almost always goes away on its own with continued use of the drug. Second, if someone DOES have to stop Atripla because of a rash, then it's obvious that the efavirenz is the culprit, and all that's necessary is to switch from efavirenz to something else. You can do this without interrupting therapy: simply switch from Atripla to Truvada plus either Prezista/Norvir, Reyataz/Norvir, or Isentress, for example. That way, there's no risk of resistance.

Your friend should get a genotype to see whether he now has the K103N mutation


LINK:

http://www.hopkins-hivguide.org/q_a/patient/antiretroviral_therapy/treatment_interruption/atripla_stopping_protocol.html?contentInstanceId=510872&siteId=7151

It is wrong for a hospital to give a patient Atripla for just 4 days and not explain to them that they must continue and give them a Rx for doing so, period. This is not debatable or a matter of opinion, it is a fact. If the patient were not able to continue with Atripla (for financial or other reasons), they could give him a Rx for about a week's worth of Truvada, this would lessen the chances of acquiring Sustiva resistance.

Whether or not he should sue is a different question. I do think it's important, as already mentioned, to bring attention to this sort of thing in order to keep it from happening to others in the future. This whole issue points to the lack of HIV/AIDS knowledge among many health care practitioners.
« Last Edit: January 27, 2010, 07:21:52 PM by Inchlingblue »

Offline RapidRod

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Re: To Sue or Not
« Reply #49 on: January 27, 2010, 07:27:37 PM »
Then you are saying no one should take nPEP? There is NO difference in what he has done for only 4 days and those that take nPEP for 28 days.

 


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