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Author Topic: What's up with people starting meds with fairly high CD4 counts?  (Read 3028 times)

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Offline kuttakamina

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What's up with people starting meds with fairly high CD4 counts?
« on: February 19, 2010, 03:43:35 AM »
I noticed several posters who started meds while their CD4s hovered around the 400, 500, 600 and higher mark, even over a period of time? Is this the new trend?

I don't get it.

Offline Matty the Damned

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Re: What's up with people starting meds with fairly high CD4 counts?
« Reply #1 on: February 19, 2010, 03:47:01 AM »
Frau Eva, the sexual health physician burdened with the management of Matty the Damned says treatment should commence at 500 CD4 cells and no fewer.

MtD

Offline veritas

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Re: What's up with people starting meds with fairly high CD4 counts?
« Reply #2 on: February 19, 2010, 05:53:28 AM »

KK,

Recent studies suggest that starting treatment earlier, prolongs life. I believe the guidelines suggest to start anywhere between 350 - 500. See this:

http://aidsinfo.nih.gov/contentfiles/StartingAnti-HIVMeds_FS_en.pdf

So, definitely start at 350 and it's probably better to start at 500 (your immune system is still strong).

v

Offline phildinftlaudy

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Re: What's up with people starting meds with fairly high CD4 counts?
« Reply #3 on: February 19, 2010, 07:48:21 AM »
My ID gave me the option of starting when I fell below 500 -- I started at 473.  She said that the further it drops the more difficult it is for some people to ever climb to a higher, more stable level.  They do worry about adherence when people starting early -- but for me that hasn't been a problem.
September 13, 2008 - diagnosed +
Labs:
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline aztecan

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Re: What's up with people starting meds with fairly high CD4 counts?
« Reply #4 on: February 19, 2010, 11:16:34 AM »
Back in 1996 when I started meds, the rule was to start at 500 or fewer CD4 cells. I started at 440 or so.

My results have been fabo, with my CD4s sometimes dipping in the 900s, but usually sticking to the 1,000 mark or better. I have been as high as 1,350.

All the while, the viral load, remained at undetectable once it attained it in 1996.

The thinking at the time was to prevent the decline and death we all had seen so much of before the cocktails were available.

Now, the researchers are looking into the long-term effect just living with the virus has on the body. What they are finding, it seems, is the constant inflammation caused by the virus leads to other physical complications.

So, the thinking today is to begin as stated above, when the CD4s are between 350 and 500. I certainly would.

HUGS,

Mark
"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline sreamer17ydr

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Re: What's up with people starting meds with fairly high CD4 counts?
« Reply #5 on: February 19, 2010, 11:48:06 AM »
The new CDC guidlines went from 350 to 500 or less. I started meds when my CD4 count was in the 600s just because my immune system is strong and I don't want to risk any damage to it that it already is. It was my own personal preference to start Atripla, my doctor said based on numbers and health I didnt need to start for years. I wanted to just because I want to prolong my immune system function to be healthy.
July 1st 09: Tested Poz
August 19th 09: CD4 Count: 566/ Viral Load: 20,653
Nov 10: CD4:623 Viral load: 57,673
Dec 13th: CD4 count 400, viral load-60,000
Feb 1 2010: CD4: 600 Viral load: 67,000
Feb 16 2010: Started Atripla
March 29 2010-CD4 Count: 740, Viral Load: Undetectable, CD4 percentage: 34%
Oct 27th,2010: CD4 Count: 620, Viral Load: Undetectable, CD4 percentage: 32%

Offline newt

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Re: What's up with people starting meds with fairly high CD4 counts?
« Reply #6 on: February 19, 2010, 02:01:56 PM »
High is an interesting word.

When your house is on a clay cliff, how far from the edge is safe? My great aunt lives in a bungalow on a clay cliff. When I was a kid the edge was 200 metres to her garden, now it's 20-30 metres. But she hasn't moved. All but one other person in her row of houses has moved though.

CD4 over 350, its a moot point. Other factors come into play, like are you feeling well or ill? Risk of heart disease... Transmission risk to partner...etc...etc... People seem to die less often and get seriously ill less often if they start with a count over 350.

A CD4 of 400-500 is not high its normal.

To my reading the evidence does not clearly support starting with a count over 500, but people will make up their own minds.

- matt
« Last Edit: February 19, 2010, 02:03:35 PM by newt »
"The object is to be a well patient, not a good patient"

Offline Ann

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Re: What's up with people starting meds with fairly high CD4 counts?
« Reply #7 on: February 19, 2010, 06:19:35 PM »


A CD4 of 400-500 is not high its normal.



It's also not low. As Newt says, it's normal.
Condoms are a girl's best friend

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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

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Offline northernguy

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Re: What's up with people starting meds with fairly high CD4 counts?
« Reply #8 on: February 19, 2010, 06:48:15 PM »
Hmm, since I'm one of those folks you described, I'll give you my reasons for starting now, with cd4 of 660: 
- My cd4 count may be "normal", but at 16% my cd4% definitely is not.  The only thing keeping the cd4 count high is my body producing an abnormally high amount of total lymphocytes, its way of fighting the virus.  How long can my body keep that up, what strain is it causing, and what if it crashed suddenly?
- Though I've been fortunate not have any OIs, I've been dealing with skin issues that continue to get worse. 
- Got Oral Hairy Leukoplakia my first "classic" AIDSy symptom if you will, last fall.
- The provincial gov't here is on a big push to get everyone with HIV onto treatment, a noble goal even more so since they're paying.  I have no financial reason not to. 

Apr 28/06 cd4 600 vl 10,600 cd% 25
Nov 8/09 cd4 510 vl 49,5000 cd% 16
Jan 16/10 cd4 660 vl 54,309 cd% 16
Feb 17/10 Started Atripla
Mar 7/10 cd4 710 vl 1,076 cd% 21
Apr 18/10 cd4 920 vl 268 cd% 28
Jun 19/10 cd4 450 vl 60 cd% 25
Aug 15/10 cd4 680 vl 205 cd% 27
Apr 3/11 cd4 780 vl <40 cd% 30
Jul 17/11 cd4 960 vl <40 cd%33
April 15/12 cd4 1,010 vl <40 cd% 39
April 20/12 Switched to Viramune + Truvada
Aug 2/12 cd4 1040, vl <40, cd% 38
Oct 19 cd4 1,110 vl <40 cd% 41

Offline tednlou2

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Re: What's up with people starting meds with fairly high CD4 counts?
« Reply #9 on: February 19, 2010, 11:07:32 PM »
I've read on here about many people starting meds immediately after infection.  I always wondered how they came to the decision--not knocking it, just curious.  I guess they are following the hit hard and early approach.

However, I recently read a study that shows this is causing tons of resistance issues.  Many people who are recently infected often feel very good for many years.  They sometimes think they can take a break from the meds.  Some experts are now saying, "Hit later and carefully."

I was trying to find the study, but haven't been able to do so yet.  I know it is in my e-mail some where.  They were talking about the pro being making an HIVer much less likely to transmit the virus and less damage to the immune system.  The con is obviously more years on the meds and more resistance issues.  And, the possibility of passing their drug resistant strain to others.
« Last Edit: February 19, 2010, 11:09:21 PM by tednlou2 »

Offline PeteNYNJ

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Re: What's up with people starting meds with fairly high CD4 counts?
« Reply #10 on: February 20, 2010, 01:55:45 AM »
Newt and Ann

What are your thoughts on %?  I started my meds while I was at 19% which was down a lot from the 35% I first tested at 4 years ago.  My CD4 was around 500-550 but I didn't want to wait for my % to go lower.

Pete

Offline CJ2009

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Re: What's up with people starting meds with fairly high CD4 counts?
« Reply #11 on: February 20, 2010, 02:12:03 AM »
As my doctor said, "There's no other virus that we won't treat right away. No doctors say, 'Hey, lets have that virus deteriorate your body to a certain point before we give you medication to help it!'"

That's SO true!

Offline Rev. Moon

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Re: What's up with people starting meds with fairly high CD4 counts?
« Reply #12 on: February 20, 2010, 02:31:54 AM »

However, I recently read a study that shows this is causing tons of resistance issues.  

I think you misread/misunderstood the bottom line from that study.
"I have tried hard--but life is difficult, and I am a very useless person. I can hardly be said to have an independent existence. I was just a screw or a cog in the great machine I called life, and when I dropped out of it I found I was of no use anywhere else."

Offline Hellraiser

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Re: What's up with people starting meds with fairly high CD4 counts?
« Reply #13 on: February 20, 2010, 01:34:55 PM »
As my doctor said, "There's no other virus that we won't treat right away. No doctors say, 'Hey, lets have that virus deteriorate your body to a certain point before we give you medication to help it!'"

That's SO true!

Yeah but the liver toxicity of the meds is being balanced against the havoc that the virus wreaks on your body.  Some people's liver or kidneys just don't handle the meds as well as it can resist the virus, for a while anyway.

If I had the option I would've started very early.
« Last Edit: February 20, 2010, 01:37:58 PM by Hellraiser »

Offline griezzel

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Re: What's up with people starting meds with fairly high CD4 counts?
« Reply #14 on: February 20, 2010, 11:44:38 PM »
Yeah but the liver toxicity of the meds is being balanced against the havoc that the virus wreaks on your body.  Some people's liver or kidneys just don't handle the meds as well as it can resist the virus, for a while anyway.
Very true, especially for the many of us coinfected with HepC. If I had started meds in 1990 when it was first recommended I might not be alive now.

In the reading I'm doing now on when to begin meds, one of the reasons for waiting given is that better drugs are always being developed for initial therapy.

Offline tednlou2

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Re: What's up with people starting meds with fairly high CD4 counts?
« Reply #15 on: February 21, 2010, 01:02:57 AM »
I think you misread/misunderstood the bottom line from that study.

Do you have the study and the link?  I know it must be in one of thebody.com's news letters I get e-mailed to me.  I'm still trying to find it.  If you have it, please share it.  I've been known to misquote things before--very rarely though..lol.

Offline Rev. Moon

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Re: What's up with people starting meds with fairly high CD4 counts?
« Reply #16 on: February 21, 2010, 01:14:10 AM »
Do you have the study and the link?  I know it must be in one of thebody.com's news letters I get e-mailed to me.  I'm still trying to find it.  If you have it, please share it.  I've been known to misquote things before--very rarely though..lol.

I honestly don't read the body.  I however recall reading these:

New resistance becoming rarer as more patients achieve undetectable HIV viral load (from Aidsmap - 05/Jan/2010)

Starting treatment at lower CD4 cell counts increases risk of HIV drug resistance (from Aidsmap - 02/Jun/2009)

And so that this doesn't become a hijack... these two articles touch on the initial question presented by the OP.

US guidelines now favour treatment at CD4 cell counts between 350 and 500; above 500 not ruled out (from Aidsmap - 01/Dec/2009)

Starting HIV treatment reduces risk of death from all causes; additional benefits if treatment started sooner (from Aidsmap - 05/Jan/2010)

"I have tried hard--but life is difficult, and I am a very useless person. I can hardly be said to have an independent existence. I was just a screw or a cog in the great machine I called life, and when I dropped out of it I found I was of no use anywhere else."

Offline northernguy

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Re: What's up with people starting meds with fairly high CD4 counts?
« Reply #17 on: February 21, 2010, 02:16:12 AM »
Forgot to add that my doc was in favour of me starting meds now as studies are beginning to show that our chances of non-AIDS cancers decrease the higher your cd4 are.  Since I've got anal dysplasia, this is a real factor for me:

...The risk of these cancers increased significantly with declining CD4 cell counts, indicating that antiretroviral therapy may be helpful in terms of minimizing the risk of various infection-related malignancies. For example, the risk of anal cancer among people with CD4 counts below 200 cells was 164 times higher compared with HIV-negative controls, whereas it was 83 times higher among those with CD4s between 201 and 499 and 34 times higher among those with CD4s of 500 or greater...

http://aidsmeds.com/articles/hiv_cancer_silverberg_1667_18035.shtml
« Last Edit: February 21, 2010, 02:17:54 AM by northernguy »
Apr 28/06 cd4 600 vl 10,600 cd% 25
Nov 8/09 cd4 510 vl 49,5000 cd% 16
Jan 16/10 cd4 660 vl 54,309 cd% 16
Feb 17/10 Started Atripla
Mar 7/10 cd4 710 vl 1,076 cd% 21
Apr 18/10 cd4 920 vl 268 cd% 28
Jun 19/10 cd4 450 vl 60 cd% 25
Aug 15/10 cd4 680 vl 205 cd% 27
Apr 3/11 cd4 780 vl <40 cd% 30
Jul 17/11 cd4 960 vl <40 cd%33
April 15/12 cd4 1,010 vl <40 cd% 39
April 20/12 Switched to Viramune + Truvada
Aug 2/12 cd4 1040, vl <40, cd% 38
Oct 19 cd4 1,110 vl <40 cd% 41

 


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