Meds, Mind, Body & Benefits > Questions About Treatment & Side Effects

06/10 Starting Viramune (Nevirapine) + Kivexa (Epzicom = 3TC / abacavir)

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eric48:
Hi,
Very rarely at at the clinic, would I meet someone looking sick. Yet, last visit was on the day the psychologist was in. The waiting room was filled with people who obviously live with the burden of past medical events or treatments...

To these people, the content of this thread may seem unrealistic and I apologize for that.

Doc visit: nothing special to expect as all numbers are in range (even LDL is low: 0.86). Doc reads the Lab report, he seems concentrated and unconcerned at the same time.

Doc : Whoa... CD4/CD8 = 1.9 (looking happily surprised)
Me : (smiling) right on my expectations
Doc : ??
Me : (smiling as if this was my moment of victory)
Doc : Don't worry it will go down (you! spoiler!)
Me: Of cause, it might, but not as far as below 1.0
Doc: Well... anyway ...This is not about entering a Guinness book contest

Doc once told me, that, as far as it comes to numbers, he sees just about anything you might think of. So as far as it is within range... Yet, he is usually very careful about predicting something (like your CD4 will go up this much, etc.). The only exception is at month 6, when VL became (finally) < 50, he ventured " and in 6 months your ratio will be over 1.0" . Which it almost did...

Me: do you know the difference between kinetics and dynamics (in general)?
Doc : No.
Me: Kinetics is when you describe things moving (up and/or down), dynamics is when you can describe AND explain by underlying forces
Doc : ??

In fact pharmacokinectics are dedicated to the determination of the fate of substances administered externally to a living organism, where as pharmacodynamics is the study of a drug's pharmacological effect on the body.

There has been a few attempts to model CD4 and CD8 dynamics, but most models have failed when confronted with patients data. The main reason is that, with almost any simple model, one assumes that some parameters remain constant for a period of time. CD4 expansion (proliferation, increase in number by cell division) is increased when a MCH class II must be controlled, and so will CD8 proliferation. These 2 expansions occur in parallel, but their decay follow their own laws (which are different). MCH class II 'attacks' may occurs at a rate/frequency higher than the follow up blood draws.

Then we went on to the physical exam. He was so close to me... While taking my BP, my arm was resting on something soft and comforting that we usually refer to 'hard'
He was wonderful, I was so pathetic, we were wonderful

Cheers!   Eric     

eric48:
Hi,

need more on  CD4/CD8 ? go to:
http://www.natap.org/2013/IAS/IAS_48.htm
Lower Peak Viral Load, Higher CD4/CD8 Ratio Linked to Low PBMC Reservoir

Yet we need mathematical model of CD4 dynamics...
It is needed to explain why a Pharma-cure is not impossible and why it has not been (and could not) fully demonstrated yet.

Our models (pending publication) now has a nickname:
Single Compression Quadratic Decay of Infected CD4s and Recovery of Uninfected CD4s (in short the SCQD model)

I will spare the reader the resolution of quadratic differential equations and, for the mathematically obsessed, in the interim, you can read this in detail, if you feel frustrated (good luck with it...)

http://www.ploscompbiol.org/article/info%3Adoi%2F10.1371%2Fjournal.pcbi.1002971

One of the lowdown of our model is that a prerequisite is that NO MCH-Class-II infection should interfere during the period of data collection. Should this happen, and it will happen, then we have to wait for the next favorable period of low immunologic activity.

This is due to the fact that any MCH-Class-II infection will trigger an unmeasurable expansion of CD4s, therefore skewing the decay of the infected cells pool by replenishing it to an unknown level.

Typical infection to trigger a immunologic response involving CD4s are: Influenza, CMV shedding, and, in other words and in the order of appearance in the screen, sorry..., clinical development of late stage AIDS..., all the AIDS-defining opportunistic infections.

Only immunocompetent patient's data can be used and ideally in a non-flu period and hopefully no CMV reactivation period.

While these are very limiting criteria of inclusion for patient's data, I have enjoyed at least 3 extended period of time where those conditions where met (being CMV neg. did help, the flu or flu vaccine, did not...) and therefore 3 calculated points of uninfected CD4 cell pool could be obtained. (please kindly bear in mind that the patient also have to get blood draws at a higher frequency than that covered by health insurance, at his own expense...)

The 3 points are:
at month : the uninfected cell pool is:
   
3   :       145
8   :      383
29 :      669

Next post, I'll put everything on graphs for easier understanding

Most likely an outlier , but still...July 16 blood drawn on a late hot afternoon...
CD4: 1400  CD4 % : 51 ; CD8 : 577  CD8 % : 21
CD4/CD8 ratio: 2.43

Makes me feel good ! Enjoy!

Eric

friskyguy:
very insightful article.......thanks eric for sharing.

Hit this disease hard and early to get below 1 viral load on meds and keep your CD4/CD8 ratio high so can keep the infected viral reservoirs low......to have your body in a better place (low reservoirs) to take advantage of a cure when it arrives.

Congrats on your awesome blood results too! Really great!

J.R.E.:
 8)

Congratulations Eric on those fantastic numbers.  I may not post often, but I do keep up with this thread !   ;)

I have some labs coming up on August 9th. The last set of numbers took about a 200 point drop in CD4, and some discussion came up, as to a possible switch in regimens. I am still on the 2 separate doses a day of Viramune, and one Epzicom. Was started on an additional dose of 10mg of Lisinopril. This was in addition to the 25mg dose of Hydrochlorothiazide, for blood pressure.

But, I am not going to rush anything, we"ll see how those results come up after the 9th.

Otherwise, All is well!

Take care of yourself !---Ray

eric48:
Hi Ray,

There is not a day where I do not think of you... Here, we are working hard here to find reservoir reducing molecules that help people move to full recovery... I will publish what I am allowed to, here, but this is not always easy (for legal reasons)

We hope to establish a new biotec company soon to finance a clinical trial. It is a lot of stress, trying to find a solution to this hurdle, but, the people I am working with are very enthusiastic. It is inspiring.

Still, I do remember your words every time I am rushing to something: one step at a time. Unless resistance occurs, I would never change my current regimen for anything else.

Like you I am on statin. The statin you are using (if my memory is correct) is not much used here any longer since there are some studies that have proven rovustatin to be superior to others.

I can assure you, we are leaving no stone unturned to try to find new keys.

Good to know you are doing fine and be sure I am with you

Eric

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