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Author Topic: Lazy CD4 #s & Creatinine elevation...Problem?  (Read 2134 times)

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Offline Billy B

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  • Posts: 374
Lazy CD4 #s & Creatinine elevation...Problem?
« on: November 26, 2010, 01:46:48 PM »
Hello all- I started Isentress & Truvada in March of this year and as you can see by my numbers I am not getting that big boost in CD4 cells that I would like.  As an older one halfway between 50 and 60 I understand that it could take a while for a rebound in CD4 cells. Although I was really concerned about my recent drop in CD4 numbers my IDS said the important thing is that I became UD so quickly and that my CD4% was rising albeit slowly which means that my combo is working.
My last set of labs also indicated a rise in my creatinine ratio. His note on it was " Your urinalysis was normal but your urine protein: creatinine ratio was slightly elevated at 0.43 (should be less than 0.2)". I don't have any muscle pain or weakness so I am not too concerned or should I be? I understand that eating to much protein before the test or being muscular can effect this test. My weight has remained stable and I have had no side effects from my combo.
Thanks,
Billy
« Last Edit: November 27, 2010, 12:01:34 AM by Billy B »
VL 4420 CD4 340 CD4% 24   3/15/10 Started I&T
VL  UD   CD4 340 CD4% 26.5 05/13/10
VL  UD   CD4 360 CD4% 27.1 08/3/10
VL  UD   CD4 310 CD4% 28.4 11/22/10
VL  UD   CD4 420 CD4% 27.9 02/11/11
VL  UD   CD4 370 CD4% 26.4 06/08/11
VL  UD   CD4 360 CD4% 27.7 09/23/11
VL  UD   CD4 370 CD4% 28.3 01/20/12
VL  UD   CD4 430 CD4% 28.8 05/11/12
VL  UD   CD4 370 CD4% 28.1 09/07/12
VL  UD   CD4 390 CD4% 32.3 03/14/13

Offline newt

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Re: Lazy CD4 #s & Creatinine elevation...Problem?
« Reply #1 on: November 26, 2010, 02:48:33 PM »
The creat test is kinda flaky, see what it is next time. Exercise can have a marked effect on this test too.

As for CD4s, well, yes, it is good to have some but 350 is more than adequate. People kinda get hung up on this but really after starting treatment, unless your CD4 is really low, like under 200, or even 100, it's not so important. The virus is asleep if your viral load is less than 50.

I believe the reason people get hung up on CD4 counts is because historically, before treatment, low CD4 count, and especially a declining CD4 count, was the door to illness and death. But treatment changed this in a big way. Just no-one noticed.

Give it 7 years then see where your CD4 is. Mine took a big leap, maybe 150 points, after 5 years on treatment. I am sure there are other people here with a similar experience.

You can waste a lot of time worrying about unreal dangers/celebrating nonexistent joys, like a +/- 50 point change in CD4 count.

Becoming undetectable as quickly as you did is a very good predictor of long term success.

The CD% increase, I like, might here be a better indicator of improvements in your immune system now you are on treatment.

- matt

Now playing: Mott the Hoople feat. David Bowie, All The Young Dudes
"The object is to be a well patient, not a good patient"

Offline mecch

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Re: Lazy CD4 #s & Creatinine elevation...Problem?
« Reply #2 on: November 26, 2010, 02:51:03 PM »
Any idea how long you have been HIV+?
Half way to 60 means 30?
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline eric48

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Re: Lazy CD4 #s & Creatinine elevation...Problem?
« Reply #3 on: November 26, 2010, 04:56:07 PM »
hi,

you question is quite similar to the one here:

http://forums.poz.com/index.php?topic=35356.0

I'd comment the same...

a few differences:
- your VL was initially low. this means that the 'benefits' of the drugs (which you so-rigthly started) are less 'impressive' than in people with VL in the millions!
Low initial VL is a predictor for slower CD4 recovery
- your are 'older': is a predictor for slower CD4 recovery, and eventually some marginal CD4 decrease

(see: http://www.iasusa.org/pub/topics/2010/issue3/121.pdf )
(see dashed lines on page 2)

if you would allow me to assume that you have been infected for a (long) while before starting the drugs, my hunch is that the continuing destruction of CD4s (in your case, this destruction was luckily quite limited, a good point...) in your system may have reduced its 'biodiversity'
so as the overall number of CD4 will be on the increase, not all pools will come back equally (or at least not at the same speed)

as you see you cd4 % go up (and in your case, it does...), you also may see your CD8 % go down and this is good news for long term recovery

Some of the sub-pools may remain a bit depleted, as I have described here:

http://forums.poz.com/index.php?topic=20327.msg440126#msg440126


Although a mere opinion of mine, if it is true , the take home lesson is that you have to be extra carefull for aged associated nasties such as cholesterol, blood sugar, smoking, cancers, etc.

but, the main reason for being carefull about these issues is not your POZ status or 'lazy' CD4s: it is the fate of everyone getting 'older'.

Aging is unavoidable. But aging with grace and style is an achievable target in life

Cheers

Eric
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0   safety stock : 3 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: NCT02157311 = 4d. ON, 3d. OFF)

Offline newt

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Re: Lazy CD4 #s & Creatinine elevation...Problem?
« Reply #4 on: November 26, 2010, 05:11:02 PM »
Erm, soz but...

Quote
your VL was initially low. this means that the 'benefits' of the drugs (which you so-rigthly started) are less 'impressive' than in people with VL in the millions!

The target is a viral load of 50 or less, so what's with the higher/lower = more/less benefit thing? There is no study to show this is a robust association, or an important one. The benefit is, in short, putting the virus to sleep, ie undetectable (less than 50 copies/mL blood) viral load. Full stop.

Quote
Low initial VL is a predictor for slower CD4 recovery

Show me a decent cohort study which suggests this is true, or, indeed, a decent study of any sort that says this is even theoretically important.

matt the newt
"The object is to be a well patient, not a good patient"

Offline tednlou2

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Re: Lazy CD4 #s & Creatinine elevation...Problem?
« Reply #5 on: November 26, 2010, 11:06:44 PM »
Show me a decent cohort study which suggests this is true, or, indeed, a decent study of any sort that says this is even theoretically important.

matt the newt

[/quote]

I was curious about this statement, too.  I've been thinking a low initial vl, if anything, may allow for a larger CD4 increase--may, not necessarily.  I would hope my having a vl usually under 15,000 wouldn't predict that I wouldn't see my CD4 increase as much as it would if I had a vl of 1 million.   

Offline Billy B

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  • Posts: 374
Re: Lazy CD4 #s & Creatinine elevation...Problem?
« Reply #6 on: November 27, 2010, 12:00:04 AM »
Any idea how long you have been HIV+?
Half way to 60 means 30?


Sorry Mecch- I should have said half way between 50 & 60 = 55 years old. I have been + for over 16 years that I know of. I only decided to start meds this year because my CD4 fell around the magic number 350. My VL has never been higher than 8000 so my IDS never really pushed the meds and let me decide when I was ready.
Billy
« Last Edit: November 27, 2010, 12:12:46 AM by Billy B »
VL 4420 CD4 340 CD4% 24   3/15/10 Started I&T
VL  UD   CD4 340 CD4% 26.5 05/13/10
VL  UD   CD4 360 CD4% 27.1 08/3/10
VL  UD   CD4 310 CD4% 28.4 11/22/10
VL  UD   CD4 420 CD4% 27.9 02/11/11
VL  UD   CD4 370 CD4% 26.4 06/08/11
VL  UD   CD4 360 CD4% 27.7 09/23/11
VL  UD   CD4 370 CD4% 28.3 01/20/12
VL  UD   CD4 430 CD4% 28.8 05/11/12
VL  UD   CD4 370 CD4% 28.1 09/07/12
VL  UD   CD4 390 CD4% 32.3 03/14/13

Offline Billy B

  • Member
  • Posts: 374
Re: Lazy CD4 #s & Creatinine elevation...Problem?
« Reply #7 on: November 27, 2010, 12:05:27 AM »
The creat test is kinda flaky, see what it is next time. Exercise can have a marked effect on this test too.

As for CD4s, well, yes, it is good to have some but 350 is more than adequate. People kinda get hung up on this but really after starting treatment, unless your CD4 is really low, like under 200, or even 100, it's not so important. The virus is asleep if your viral load is less than 50.

I believe the reason people get hung up on CD4 counts is because historically, before treatment, low CD4 count, and especially a declining CD4 count, was the door to illness and death. But treatment changed this in a big way. Just no-one noticed.

Give it 7 years then see where your CD4 is. Mine took a big leap, maybe 150 points, after 5 years on treatment. I am sure there are other people here with a similar experience.

You can waste a lot of time worrying about unreal dangers/celebrating nonexistent joys, like a +/- 50 point change in CD4 count.

Becoming undetectable as quickly as you did is a very good predictor of long term success.

The CD% increase, I like, might here be a better indicator of improvements in your immune system now you are on treatment.

- matt

Now playing: Mott the Hoople feat. David Bowie, All The Young Dudes


Matt- Thanks for the answer and you hit the stress issue on the head!
Billy
BTW I love Mott the Hoople & Bowie
VL 4420 CD4 340 CD4% 24   3/15/10 Started I&T
VL  UD   CD4 340 CD4% 26.5 05/13/10
VL  UD   CD4 360 CD4% 27.1 08/3/10
VL  UD   CD4 310 CD4% 28.4 11/22/10
VL  UD   CD4 420 CD4% 27.9 02/11/11
VL  UD   CD4 370 CD4% 26.4 06/08/11
VL  UD   CD4 360 CD4% 27.7 09/23/11
VL  UD   CD4 370 CD4% 28.3 01/20/12
VL  UD   CD4 430 CD4% 28.8 05/11/12
VL  UD   CD4 370 CD4% 28.1 09/07/12
VL  UD   CD4 390 CD4% 32.3 03/14/13

Offline ElZorro

  • Member
  • Posts: 535
Re: Lazy CD4 #s & Creatinine elevation...Problem?
« Reply #8 on: November 27, 2010, 02:14:43 AM »
- your VL was initially low. this means that the 'benefits' of the drugs (which you so-rigthly started) are less 'impressive' than in people with VL in the millions!
Low initial VL is a predictor for slower CD4 recovery
- your are 'older': is a predictor for slower CD4 recovery, and eventually some marginal CD4 decrease

what are these "facts" based on?


Billy -

16 years poz with the numbers you're talking about?  Wow! Sounds like you've got one of those MC Hammer immune systems that says "Can't Touch This" to HIV  ;)
« Last Edit: November 27, 2010, 02:17:45 AM by ElZorro »

Offline Inchlingblue

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Re: Lazy CD4 #s & Creatinine elevation...Problem?
« Reply #9 on: November 27, 2010, 09:15:41 AM »
I'm confused between creatinine, CPK (creatine phosphokinase) and CK (creatine kinase).

It seems they all have a connection with muscle function and/or muscle damage.

Here is an explanation from Dr. Gallant and it's still not clear to me:

LINK: http://forums.poz.com/index.php?topic=32239.msg396052#msg396052


The CPK (or CK) has been known to become elevated with some people on Isentress. I guess this is different from creatinine levels used to measure GFR?

Re: the correlation between viral load levels and CD4 recovery. This has come up before, I can't find the link. There has been found to be a general correlation between them but I believe it only applies to the initial CD4 recovery for the first few months after starting meds. I.e. the higher the viral load at the time one starts meds the higher the initial CD4 recovery. Starting meds with a lower viral load usually means less of a dramatic jump in CD4s soon after starting meds. This is a general correlation and can vary among individuals. I'll keep trying to look for the link and post it if I can find it.

In my own experience I started meds with about 390 CD4s and a low viral load of about 12K. My initial jump in CD4s after starting meds was not that dramatic but over the course of a year they did slowly keep going up to the 900s.

I thought this was interesting, even though the OP is not yet at 500 CD4s:

In general, the CD4 count is felt to be more important (though more variable) than the CD4 percent. But once your viral load is undetectable and your CD4 count is above 500, your focus should be entirely on the viral load. At that point, the CD4 count and percent really don't matter anymore. I've started measuring them no more than once a year in such people.

LINK:

http://www.hopkins-aids.edu/question_of_the_month/qweek/re__re__re__starting_haart_during_acute_hiv_infection.html?siteId=7151&contentInstanceId=535028
« Last Edit: November 27, 2010, 09:44:07 AM by Inchlingblue »

Offline Billy B

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  • Posts: 374
Re: Lazy CD4 #s & Creatinine elevation...Problem?
« Reply #10 on: November 27, 2010, 10:25:08 AM »
what are these "facts" based on?


Billy -

16 years poz with the numbers you're talking about?  Wow! Sounds like you've got one of those MC Hammer immune systems that says "Can't Touch This" to HIV  ;)

ElZorro- I have always felt very fortunate to have been able to go so long without meds. When I first tested + my CD4 was 495 and generally went up & down between (495-400) & VL was 2300.  My IDS has a large practice he said that he only has six patients with the similar ability to mostly controll the virus for so many years. I felt fine when I started meds and I am still working 50 hours a week.
Billy
VL 4420 CD4 340 CD4% 24   3/15/10 Started I&T
VL  UD   CD4 340 CD4% 26.5 05/13/10
VL  UD   CD4 360 CD4% 27.1 08/3/10
VL  UD   CD4 310 CD4% 28.4 11/22/10
VL  UD   CD4 420 CD4% 27.9 02/11/11
VL  UD   CD4 370 CD4% 26.4 06/08/11
VL  UD   CD4 360 CD4% 27.7 09/23/11
VL  UD   CD4 370 CD4% 28.3 01/20/12
VL  UD   CD4 430 CD4% 28.8 05/11/12
VL  UD   CD4 370 CD4% 28.1 09/07/12
VL  UD   CD4 390 CD4% 32.3 03/14/13

Offline Billy B

  • Member
  • Posts: 374
Re: Lazy CD4 #s & Creatinine elevation...Problem?
« Reply #11 on: November 27, 2010, 10:55:59 AM »
I'm confused between creatinine, CPK (creatine phosphokinase) and CK (creatine kinase).

It seems they all have a connection with muscle function and/or muscle damage.

Here is an explanation from Dr. Gallant and it's still not clear to me:

LINK: http://forums.poz.com/index.php?topic=32239.msg396052#msg396052


The CPK (or CK) has been known to become elevated with some people on Isentress. I guess this is different from creatinine levels used to measure GFR?

Re: the correlation between viral load levels and CD4 recovery. This has come up before, I can't find the link. There has been found to be a general correlation between them but I believe it only applies to the initial CD4 recovery for the first few months after starting meds. I.e. the higher the viral load at the time one starts meds the higher the initial CD4 recovery. Starting meds with a lower viral load usually means less of a dramatic jump in CD4s soon after starting meds. This is a general correlation and can vary among individuals. I'll keep trying to look for the link and post it if I can find it.

In my own experience I started meds with about 390 CD4s and a low viral load of about 12K. My initial jump in CD4s after starting meds was not that dramatic but over the course of a year they did slowly keep going up to the 900s.

I thought this was interesting, even though the OP is not yet at 500 CD4s:

In general, the CD4 count is felt to be more important (though more variable) than the CD4 percent. But once your viral load is undetectable and your CD4 count is above 500, your focus should be entirely on the viral load. At that point, the CD4 count and percent really don't matter anymore. I've started measuring them no more than once a year in such people.

LINK:

http://www.hopkins-aids.edu/question_of_the_month/qweek/re__re__re__starting_haart_during_acute_hiv_infection.html?siteId=7151&contentInstanceId=535028

Inchlingblue- I knew that Isentress could cause elevated levels and Assurbanipal had to stop because muscle damage. I discussed this with my IDS and asked him to check my level. The lab request  box he checked read CK/CPK. I have an appointment with a Nephorologist after the holidays to have a full kidney evaluation ( the 24 hr filtration rate) test.
Billy
« Last Edit: November 27, 2010, 11:29:57 AM by Billy B »
VL 4420 CD4 340 CD4% 24   3/15/10 Started I&T
VL  UD   CD4 340 CD4% 26.5 05/13/10
VL  UD   CD4 360 CD4% 27.1 08/3/10
VL  UD   CD4 310 CD4% 28.4 11/22/10
VL  UD   CD4 420 CD4% 27.9 02/11/11
VL  UD   CD4 370 CD4% 26.4 06/08/11
VL  UD   CD4 360 CD4% 27.7 09/23/11
VL  UD   CD4 370 CD4% 28.3 01/20/12
VL  UD   CD4 430 CD4% 28.8 05/11/12
VL  UD   CD4 370 CD4% 28.1 09/07/12
VL  UD   CD4 390 CD4% 32.3 03/14/13

Offline Assurbanipal

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Re: Lazy CD4 #s & Creatinine elevation...Problem?
« Reply #12 on: November 27, 2010, 02:04:07 PM »
Hi Billy

Hope things go well for you.  It sounds like they are going pretty well and that you have a conscientious doctor, so... so far, so good.  Problems with Isentress are pretty rare, after all.  I hope you can try not to stress out over it too much (but I know that is easier said than done).

For what it is worth, here's my current understanding of the CPK/creatinine/Isentress issues.   I spent some time looking into this to try to get it clear in my head, but -- warning -- biochemistry was 3 decades ago....

The concern with Isentress is that in rare cases it may  cause rhabdomyolosis -- the breakdown of muscle fiber in the body.  There is a description of it here http://www.nlm.nih.gov/medlineplus/ency/article/000473.htm

Isentress is not the only cause of rhabdomyolosis.  Statins (used to bring down cholesterol) can also cause it, as can other things (of which the only one that applied in my case was that I had started training to run a marathon).  The first step we took was to discontinue the statin (pravachol) that I was on and I gave up on trying for a marathon.  Since my cholesterol issues were primarily related to the protease inhibitors I had replaced with Isentress, my docs were fine with getting rid of the statin (and my cholesterol levels did, indeed, remain fine while I was on Isentress). 

CPK levels stayed very high and other tests went increasingly out of whack as well, so I was taken off Isentess (quite abruptly) and told to drink LOTS of water. 

As far as symptoms were concerned, I had some muscle tenderness and soreness and some joint pain, but it was not enormous and did not seem inconsistent with the sort of increases in aches etc that come along in one's 50's  -- especially since I had never tried to do a marathon before.  But the soreness and pain did persist after I stopped training.   I also had somewhat darker urine than normal -- but not alarmingly so.  The main indicators for me were rapidly increasing CPK levels, and increasingly bad kidney and liver tests.  Rhabdomyolosis can harm the kidneys, so that was seen as somewhat of a verification of harm as reported by the high CPK levels.

It took about 4-6 months for my routine lab results (kidney and liver) to get back to normal after I stopped Isentress.



Inchling,

With regards to the differences between creatine, CPK, creatinine...

When muscles break down they leak creatine phosphokinase (CPK). 

CPK is also known as creatine kinase (CK) -- they are the same thing.  (A "kinase" describes a part of the biology of the cell that transfers phosphate groups from Adenosine triphosphate (ATP) and adds them to another compound.   -- CPK is part of the cell energy transfer and storage mechanism. ) Creatine kinase does not contain creatine -- it is an enzyme that transforms creatine into phosphocreatine.

The test for high CPK/CK levels is NOT part of a routine blood test that many of us get.  It is a separate test to see whether the enzyme is leaking out of your muscles at an unusual rate


Creatinine is a by-product of phosphocreatine.  Think of it as a damaged version of phosphocreatine after it has been "used up".  It is produced by your body's normal processes and cleared out by your kidneys on a pretty consistent basis.  Because it is routinely produced and cleared out by your kidneys it is used as a marker for how well the kidneys are working.  If creatinine levels are high, the kidneys may be "stopped up". Measurement of creatinine levels is part of the CMP (comprehensive metabolic panel) that many people routinely get as a part of their blood tests.  The creatinine level is usually separately reported and is also part of the measurement of kidney function (GFR --glomerular filtration rate)

So, CPK is the same as CK.  It is an enzyme that changes creatine into phosphocreatine. Think of creatine as a raw material and CK as a tool that transforms it.  Once phosphocreatine is "used up" it becomes creatinine and is cleared by your kidneys.  Because this is a pretty routine event, creatinine clearance rates are used as a general marker for how well your kidneys are working.

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: Lazy CD4 #s & Creatinine elevation...Problem?
« Reply #13 on: November 27, 2010, 04:00:02 PM »
Thank u Assurbanipal, that helps explain things.

Offline eric48

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Re: Lazy CD4 #s & Creatinine elevation...Problem?
« Reply #14 on: November 27, 2010, 07:10:41 PM »
hi guys,

I hate myself for making pedantic statements and as much as I can , I try to back up with serious and easily available data (free articles)

Some times difficult because :
A/ I am not a librarian with thousands on references on top of my head and
B/ I have (at work) free access to publications are are only accessible if you have the proper subscription  (it would be useless to point to these publications)
C/ I refrain from bookmarking (at work)

I did not sufficiently backed up my statement that a lower VL and age are predictors for slower CD4 recovery because
A/ I have read it numerous times, and thought (obviously wrong fully) that this is 'common knowledge'
B/ I maintain a list of links of interest (to my own circumstances that indeed include age but not low VL - I was on the higher VL side of the spectrum)

I do not mind being challenged on statements I make. It is rather challenging and helps educate oneself.
I am trying herebelow to answer to the challenge:

Show me a decent cohort study which suggests this is true...
('this' referring to my statement : Low initial VL is a predictor for slower CD4 recovery)

I was hoping Googling would easily bring up the answer. but, as we all know, thousands and thousands of articles are being published and I could not retrieve the one artice I had in mind. Sorry for that.

I will not keep looking since I have found something more relevant to both the 'challenge' and to the OP.

in his OP , BillyB has 2 concerns: a lazy CD4 and a creatinine issue. I have concentrated on the CD4 side of the question...

If rephrased, BillB's question is that his recovery in CD4 is less than he would have expected (I hope understood well...)

I think the proper term for it is discordant recovery. You are doing fine, you wait until you are comfortable with going with HAART and, despite a nice and quick UD, your CD4 are not sky rocketing, to say the least.
This is not so uncommon.

People have various concerns (I have mine, with a slower the expected VL decrease), yet, I believe that a well documented answer has a better chance to help the poster deal with his anxiety.
Even if the answer come with no-so-good-news. In BillyB's profile and my answer there are some encouraging aspects and some that are less... Hence the anxiety

The challenge go further :

... a decent study of any sort that says this is even theoretically important...

(in my humble opinion, it is not so important that it is theoretically important, but that it is clinically important)

In my search for a proper answer I found one article that is right on the topic:

http://www.ncbi.nlm.nih.gov/pubmed/19732175

let me quote some of what the abstract says (for the busy reader):

1- discordant means : CD4 count increase < 100 cells/microL from baseline (BillyB's case...)
2- A discordant response was associated with older age, lower baseline VL
3- and (at 12 months) higher baseline CD4 cell count (I underline this one since it could mean good news for Billy)
Clinically relevant ? :
4- In a multivariate analysis it was associated with an increased risk of death, more strongly at 12 months [...] but not with new AIDS events.
5-Discordant responders have a worse outcome, but assessment at 12 months may be preferred, given the number of 'slow' responders.
And the most important one (for BillyB and fellow discordant responders)
6 -Management strategies to improve outcomes for discordant responders need to be investigated.

Once again, I apologize for the long post, but I did so in hope that it would help concerned individuals come to terms with their legitimate concerns.

As for the challenge, please be assured I am not taking it personally, in fact, I rather enjoyed it !

Stay in good health. your fate is not dictated by stats!

Cheers!

Eric

side note: other articles of interest are:

http://www.ncbi.nlm.nih.gov/pubmed/20974294
http://www.ncbi.nlm.nih.gov/pubmed/21044307
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0   safety stock : 3 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: NCT02157311 = 4d. ON, 3d. OFF)

Offline eric48

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Re: Lazy CD4 #s & Creatinine elevation...Problem?
« Reply #15 on: November 27, 2010, 07:38:44 PM »

Becoming undetectable as quickly as you did is a very good predictor of long term success.

The CD% increase, I like, might here be a better indicator of improvements in your immune system now you are on treatment.

- matt
[/font]

Hi Matt,

I feel comfortable with your comment on the  CD% increase.

Being a slow VL responder myself, would you mind provide links/data/etc. backing your statement that :

Becoming undetectable [...] quickly [...] is a very good predictor of long term success.

I'd be interested, as, in fact, I am currently doing some research on this topic and I am getting to the opinion (opinion, not robust scientific evidence, I must admit at this point) that this is not necessarily true, especially for the older individual...

As I have answered (within the limits of my abilities) to your above 'challenge', I am sincerely looking forward to your answer.

Thanks in advance

Eric
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0   safety stock : 3 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: NCT02157311 = 4d. ON, 3d. OFF)

Offline Billy B

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Re: Lazy CD4 #s & Creatinine elevation...Problem?
« Reply #16 on: November 28, 2010, 12:07:45 AM »
Thanks you all for a lot of great information. Who knows, I may never get big CD4 numbers but as long as I am UD, without any OIs and don't damage my muscles or kidneys I will be happy. The Isentress & Truvada is so easy to take that I would hate to have to change to another med combo.
Billy
« Last Edit: November 28, 2010, 01:18:05 AM by Billy B »
VL 4420 CD4 340 CD4% 24   3/15/10 Started I&T
VL  UD   CD4 340 CD4% 26.5 05/13/10
VL  UD   CD4 360 CD4% 27.1 08/3/10
VL  UD   CD4 310 CD4% 28.4 11/22/10
VL  UD   CD4 420 CD4% 27.9 02/11/11
VL  UD   CD4 370 CD4% 26.4 06/08/11
VL  UD   CD4 360 CD4% 27.7 09/23/11
VL  UD   CD4 370 CD4% 28.3 01/20/12
VL  UD   CD4 430 CD4% 28.8 05/11/12
VL  UD   CD4 370 CD4% 28.1 09/07/12
VL  UD   CD4 390 CD4% 32.3 03/14/13

Offline newt

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  • the one and original newt
Re: Lazy CD4 #s & Creatinine elevation...Problem?
« Reply #17 on: November 28, 2010, 05:25:13 AM »
Eric

There are many studies, eg:

The use of plasma HIV RNA as a study endpoint in efficacy trials of antiretroviral drugs.
http://www.ncbi.nlm.nih.gov/pubmed/10853978

A rather badly worded abstract, but a rigorous review of drug efficacy studies which concludes;

"...plasma HIV RNA is a suitable study endpoint that is likely to predict a decreased risk for AIDS progression and death. Because greater and more sustained reductions in HIV RNA appear to confer greater reductions in clinical risk, maintaining maximal suppression of plasma HIV RNA, particularly below the limits of assay quantification, appears to be a rigorous benchmark for assessing the efficacy of antiretroviral regimens."

And this:

Clinical progression of HIV-1 infection according to the viral response during the first year of antiretroviral treatment. Groupe d'Epidémiologie du SIDA en Aquitaine (GECSA).
http://www.ncbi.nlm.nih.gov/pubmed/10853978

Which found (in the results section):

"A large initial viral reduction was also a protective factor for clinical progression (HR, 0.51 for 1 log10 copies/ml increase of the reduction; 95% CI, 0.31-0.85) and was associated with the viral response during the subsequent 4-12 month period. No patient with a reduction < 0.5 log10 copies/ml in the first month was classified as a good responder in the subsequent 4-12 month period"

HR = hazard ratio, and an HR of 0.51 here means roughly a 50% reduction in risk of progression per 1 log reduction in viral load, ie each '0' off the end of the viral load count.

And from the ART Collaborative Cohort (ART-CC), a large, international study looking at outcomes for people on antiretroviral therapy:

Prognostic importance of initial response in HIV-1 infected patients starting potent antiretroviral therapy: analysis of prospective studies.
http://www.ncbi.nlm.nih.gov/pubmed/12957089?dopt=AbstractPlus

Which found:

"Compared with patients who had a 6-month HIV-1 RNA of 100000 copies/mL or greater, adjusted hazard ratios for AIDS or death were 0.59 (0.41-0.86) for 10000-99999 copies/mL, 0.42 (0.29-0.61) for 500-9999 copies/mL, and 0.29 (0.21-0.39) for 6-month HIV-1 RNA of 500 copies/mL or fewer."

HIV-1 RNA here = viral load.

This confirms the reduction in risk in the GESCA paper (which is perhaps unsurprising since ART-CC cohort shares some people with the GESCA cohort).

Of note, the ART-CC paper reports that baseline CD4 and viral load is not associated with progression after starting treatment, it is the how your numbers look at 6 months that matters.

- matt


Edited for spelling
« Last Edit: November 28, 2010, 02:03:29 PM by newt »
"The object is to be a well patient, not a good patient"

Offline Billy B

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Re: Lazy CD4 #s & Creatinine elevation...Problem?
« Reply #18 on: November 28, 2010, 10:42:25 AM »
newt- Thank you for posting all those studies. This appears to support your original reply to my post.
Billy
VL 4420 CD4 340 CD4% 24   3/15/10 Started I&T
VL  UD   CD4 340 CD4% 26.5 05/13/10
VL  UD   CD4 360 CD4% 27.1 08/3/10
VL  UD   CD4 310 CD4% 28.4 11/22/10
VL  UD   CD4 420 CD4% 27.9 02/11/11
VL  UD   CD4 370 CD4% 26.4 06/08/11
VL  UD   CD4 360 CD4% 27.7 09/23/11
VL  UD   CD4 370 CD4% 28.3 01/20/12
VL  UD   CD4 430 CD4% 28.8 05/11/12
VL  UD   CD4 370 CD4% 28.1 09/07/12
VL  UD   CD4 390 CD4% 32.3 03/14/13

Offline eric48

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Re: Lazy CD4 #s & Creatinine elevation...Problem?
« Reply #19 on: November 28, 2010, 12:50:30 PM »
Thanks a lot Matt,

I know understand where your thoughts come from.

Your posts (on other threads) have also been very helpfull

Eric
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0   safety stock : 3 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: NCT02157311 = 4d. ON, 3d. OFF)

 


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