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Author Topic: Okay To Stop Checking CD4 Count?  (Read 2646 times)

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Offline tednlou2

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Okay To Stop Checking CD4 Count?
« on: January 04, 2011, 01:37:32 AM »
I just read this and thought it may be of interest to those on meds and in the situation Dr. Gallant describes. 


Labs- when to draw?

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

Posted on Dec 29, 2010
--------------------------------------------------------------------------------
I've been undetectable for over five years and currently on Isentress, Prezista, and Norvir. Is the 3-month lab draw still considered standard, or would you draw labs after 4 or possibly 6 months if someone is doing well and doesn't have viral "blips?"

On Dec 31, 2010 Joel E. Gallant, M.D., M.P.H. replied:

--------------------------------------------------------------------------------
Current guidelines recommend that viral load testing every 3-4 months and CD4 count monitoring every 3-6 months in people on therapy. However, those guidelines could change. I am now drawing labs every 4 months in people who have been doing well on therapy for over a year or two, and every 6 months in those who have maintained undetectable viral loads for several years.

I am also beginning to monitor CD4 count less frequently in people who are doing well. Once your viral load is undetectable and your CD4 count is consistently above 200, the CD4 count becomes mostly irrelevant, since you'd almost never change therapy based on CD4 results alone. I think a yearly CD4 count is sufficient in people with CD4 counts above 200, and for those consistently above 500, you could probably stop measuring them altogether. However, most of my patients resist that approach, because not measuring CD4 seems like such a radical idea.

Offline leatherman

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Re: Okay To Stop Checking CD4 Count?
« Reply #1 on: January 04, 2011, 01:56:16 AM »
However, most of my patients resist that approach, because not measuring CD4 seems like such a radical idea.
LOL Seeing how some react to a something as trivial as a 10+/- change, I don't doubt that people think its a radical idea.  :D it would be nice it treatment was guaranteed to get everyone that stable, as it might take some of the onus off variable cd4s as the end-all-be-all health marker. Perhaps in future years we will see more and more people stable enough to go so long between cd4 tests.
leatherman (aka mIkIE)


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

Offline buginme2

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Re: Okay To Stop Checking CD4 Count?
« Reply #2 on: January 05, 2011, 10:18:46 PM »
If once a viral load is undetectable would a cd4 count normally change?  If not a check of once a year sounds adequate as long as the viral load remains undetectable.  As long as there is measurable virus I would still want a regualr CD4 check.

Offline GSOgymrat

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Re: Okay To Stop Checking CD4 Count?
« Reply #3 on: January 05, 2011, 10:33:43 PM »
Having been undetectable for going on 8 years I have decided to have a complete physical, including all labs, on my birthday month and a check up six months later. I'll get my viral load checked at the six month check up and leave it to my PCP if he wants additional labs.

Of course if something medically come up I will get it looked at. Last week I had a unusual pain in my chest and even though I strongly suspected it was nothing I went to our hospital's urgent care to get checked out. After an EKG and an exam the doctor said I stressed the tendon where my pecs meet my breast bone. HIV has taught me not to let things go unexamined and it was worth the $5 copay to have peace of mind.

Offline Inchlingblue

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Re: Okay To Stop Checking CD4 Count?
« Reply #4 on: January 05, 2011, 10:33:59 PM »
What Dr. Gallant says, as usual, makes sense but, as far as checking the CD4s, I suspect most of us are just plain curious about what the CD4 count is and I think it's good to know, psychologically.

My doctor and I have agreed that from now on I'll be going in every 6 months for labs and I do want to see what my CD4 count is but it's only twice a year so it's no big deal. I went in December 2010 and won't be back for labs again until about June 2011.

Mentally, emotionally, I feel much better not having to go every 3 months. It makes me feel more "normal."

 
« Last Edit: January 05, 2011, 11:06:21 PM by Inchlingblue »

Offline leatherman

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Re: Okay To Stop Checking CD4 Count?
« Reply #5 on: January 06, 2011, 12:52:53 AM »
If once a viral load is undetectable would a cd4 count normally change?
oh gosh yes! ;D for everyone - poz or neg!

they can be higher in the evening than in the morning (by 100+)
they are lower the first 30 - 60 mins after exercise; but then rise the following hour
stress and small illnesses can lower them temporarily.

(theoretically, you could get the best results by exercising from 630-700pm and then having your blood drawn at 8pm :D)

cd4s are actually pretty fluid. that's why it's always recommended to look at the trends over time.
in a way a single cd4 test, or even 2 in a row, is a terrible way to judge the state of your health.
leatherman (aka mIkIE)


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

Offline edfu

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Re: Okay To Stop Checking CD4 Count?
« Reply #6 on: January 06, 2011, 01:19:06 AM »
As much as I admire Dr. Gallant, I am greatly surprised that his evaluation completely ignores all the recent research indicating that maintaining CD4 counts above 500, if possible, is essential to decreasing ongoing inflammation and concomitantly decreasing the incidence of co-morbidities, especially cancers of various types.  See, for example:

http://www.aidsmeds.com/articles/hiv_cancer_silverberg_1667_18035.shtml

http://www.aidsmap.com/page/1436376/
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline tednlou2

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Re: Okay To Stop Checking CD4 Count?
« Reply #7 on: January 06, 2011, 01:32:32 AM »
Having been undetectable for going on 8 years I have decided to have a complete physical, including all labs, on my birthday month and a check up six months later. I'll get my viral load checked at the six month check up and leave it to my PCP if he wants additional labs.

Of course if something medically come up I will get it looked at. Last week I had a unusual pain in my chest and even though I strongly suspected it was nothing I went to our hospital's urgent care to get checked out. After an EKG and an exam the doctor said I stressed the tendon where my pecs meet my breast bone. HIV has taught me not to let things go unexamined and it was worth the $5 copay to have peace of mind.

I'm glad to hear it wasn't anything serious.  I feel the way you do about not letting things go unchecked.  Having said that, I've been having these strange pains that feel like they shoot up from around my stomach or around the liver.  I've told myself it is probably my bowels or even anxiety related, so I've just let it go.  I have my regular doc appt Monday, so I'll ask about it then.  Even though my liver numbers are always good (besides a couple times just over the normal limit), I have concern about the Tylenol I have to take due to really bad back problems where I've had back surgery.  This comes at a time where I've had this throat thing going on where I'm losing my voice.  No fever or anything, so I've let that go unchecked, too.  I'm trying to not freak out about everything and not run to the doc for everything.  Chest pains, like yours, are a different story.  

About the CD4 issue-- I was a little surprised Dr. Gallant suggested that someone doing well on meds could just stop having their CD4 checked at all, and not just every 6-12 months.  

Offline Hellraiser

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Re: Okay To Stop Checking CD4 Count?
« Reply #8 on: January 06, 2011, 02:16:43 AM »
I actually hesitated to mention this earlier, but I have already started stretching my labs out to 6 months, if the next 2 visits are both good I will probably move to the year mark.  If I for some reason went off my meds (involuntarily) then I would go to the doctor ASAP, but I trust the meds, and I think that if anything were going on I would notice it sooner rather than later.  I expect ridicule for this stance in no less than 30 minutes, don't disappoint me!

Online RapidRod

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Re: Okay To Stop Checking CD4 Count?
« Reply #9 on: January 06, 2011, 06:19:14 AM »
I actually hesitated to mention this earlier, but I have already started stretching my labs out to 6 months, if the next 2 visits are both good I will probably move to the year mark.  If I for some reason went off my meds (involuntarily) then I would go to the doctor ASAP, but I trust the meds, and I think that if anything were going on I would notice it sooner rather than later.  I expect ridicule for this stance in no less than 30 minutes, don't disappoint me!
When it happens you'll notice it's to late. Just hope you can survive the outcome.

Offline Dachshund

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Re: Okay To Stop Checking CD4 Count?
« Reply #10 on: January 06, 2011, 07:34:13 AM »
I actually hesitated to mention this earlier, but I have already started stretching my labs out to 6 months, if the next 2 visits are both good I will probably move to the year mark.  If I for some reason went off my meds (involuntarily) then I would go to the doctor ASAP, but I trust the meds, and I think that if anything were going on I would notice it sooner rather than later.  I expect ridicule for this stance in no less than 30 minutes, don't disappoint me!

I've been doing the twice a year labs for quite some time now. Actually my doc suggested it and I'm comfortable with our decision. I'd do once a year if he would let me.

Online Miss Philicia

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Re: Okay To Stop Checking CD4 Count?
« Reply #11 on: January 06, 2011, 10:42:59 AM »
My doctor said theoretically I could do every six months, but since I go to a clinic their hands are tied due to funding that stipulates all patients must be evaluated at minimum every four months.  In terms of viral load I'd not want to go longer than every six months.  If something happens in month #2 after your annual visit you're going to be quite screwed by the time you month #12 visit comes around.

It's not like going to the doctor is that big of a deal... whatever.  I guess if you have a co-pay of $500 it's a different story, but I've not yet read of such things on here yet.  And what's the cost of a simple cd4 count measurement?  Is there some huge cost savings by doing that one only every 12 months?  IIRC it's the viral load test that's the more expensive test.  I used to have all of this stuff performed every month so I figure I'm still saving everyone money by now just going every 4 months.
"Iíve slept with enough men to know that Iím not gay"

Offline skeebo1969

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Re: Okay To Stop Checking CD4 Count?
« Reply #12 on: January 06, 2011, 12:43:49 PM »
I actually hesitated to mention this earlier, but I have already started stretching my labs out to 6 months, if the next 2 visits are both good I will probably move to the year mark.  If I for some reason went off my meds (involuntarily) then I would go to the doctor ASAP, but I trust the meds, and I think that if anything were going on I would notice it sooner rather than later.  I expect ridicule for this stance in no less than 30 minutes, don't disappoint me!

As long as those numbers are going on the walls of truckstop bathrooms across America you should still get a STD panel done monthly at the very least.  By the way, I never did receieve that case of Orange Nehi.

My wife and I go every 6 months now.   During her last visit she experienced a drop of over 400 Cd4 while maintaining an undetectable viral load.. the doctor mover her next apppointment up a bit due to this.   
I despise the song Love is in the Air, you should too.

Offline elf

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Re: Okay To Stop Checking CD4 Count?
« Reply #13 on: January 06, 2011, 03:44:00 PM »
I see my doc every 5 months.
I would prefer a 12 month period tho'.  :o
« Last Edit: January 06, 2011, 03:53:08 PM by elf »
Let's have a Kiki!

Offline skeebo1969

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Re: Okay To Stop Checking CD4 Count?
« Reply #14 on: January 06, 2011, 04:00:51 PM »
I see my doc every 5 months.
I would prefer a 12 month period tho'.  :o

I highly doubt that, my wife has a period that last 6 days and it's brutal.
I despise the song Love is in the Air, you should too.

Offline next2u

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Re: Okay To Stop Checking CD4 Count?
« Reply #15 on: January 11, 2011, 02:20:30 PM »
I asked my dr at my last appt if I could move to a 4 month or 6 month testing interval. Because I just started meds he is not comfortable with me checking in every 6 months and we may move to a 4 month model pending my next set of labs.

Best,
d
midapr07 - seroconversion
sept07 - tested poz
oct07 cd4 1013; vl 13,900; cd4% 41
feb08 cd4  694;  vl 16,160; cd4% 50.1
may08 cd4 546; vl 91,480; cd4% 32
aug08 cd4 576; vl 48,190; cd4% 40.7
dec08 cd4 559; vl 63,020; cd4% 29.4
feb09 cd4 464; vl 11,000; cd4% 26
may09 cd4 544; vl 29,710; cd4% 27.2
oct09 cd4 ...; vl 23,350; cd4% 31.6
mar10 cd4 408; vl 59,050; cd4% 31.4
aug10 cd4 328; vl 80,000; cd4% 19.3 STARTED ATRIPLA
oct10 cd4 423; vl 410 ;); cd4% 30.2
jun11 cd4 439; vl <20 ;); cd4% 33.8 <-Undetectable!
mar12 cd4 695; vl ud; cd4% 38.6
jan13 cd4 738; vl ud; cd4% 36.8
aug13 cd4 930; vl ud; cd4% 44.3
jan14 cd4 813; vl ud; cd4% 42.8
may14 cd4 783; vl *; cd4%43.5

Offline Hellraiser

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Re: Okay To Stop Checking CD4 Count?
« Reply #16 on: January 11, 2011, 03:23:42 PM »
I just had my first set of 6 month labs, I'll be sure to post the numbers soon.  Fingers crossed it's all good.  New Doctor so once again 12 vials of blood.  I am absolutely drained.  Just a reminder that I'm thankful for all the support I get from this site despite some of the silly bickering we get into.  Love y'all.

Offline odyssey

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Re: Okay To Stop Checking CD4 Count?
« Reply #17 on: January 11, 2011, 04:59:53 PM »
I just had my three months labs last Thursday including CD4 count and percentage and such. You know, even if I'm eligible at some point to move my testing out to every six months, I'll probably still insist on coming in for tests every three months. I just like the security of knowing we'll catch something sooner rather than later. And no, I would never stop checking my CD4!

odyssey
01/09/09- diagnosed HIV+
01/16/09   CD4-425    22%  VL- 32,415
11/09- started Reyetaz/Norvir/Truvada
03/10- stopped R/N/T
10/18/11   CD4- 328   20%  VL- 84,000
10/25/11   CD4- 386   22%
10/28/11- start Truvada/Reyetaz/Norvir
12/30/11  CD4- 523  29%
03/08/12  CD4- 503  31%  VL 57
07/02/12  CD4- 897  43%
08/31/12  CD4- 745  39%
12/27/12  CD4- 884  40%
03/28/13  CD4- 819  39%
07/19/13  CD4- 739  40%
10/17/13  CD4- 535  36%
01/16/14  CD4- 743  43%

02/14- switched from R/N/T to Tivicay/Epzicom because of CKD 3 suspected from tenofovir.

03/14- switched back to R/N/T due to severe nausea and inability to eat on T/E.
 
04/01/14 CD4- 898  42%   VL-

Offline mecch

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Re: Okay To Stop Checking CD4 Count?
« Reply #18 on: January 11, 2011, 06:24:16 PM »
I wonder if this is saving on costs. (less frequent CD4 for people whom Doctors think really dont need them).  I guess if this savings helps keeps costs down, and thats for the general good of a population, why not.

It also seems a gesture with psychological and PR benefits for HIV+ people.


ďFrom each, according to his ability; to each, according to his needĒ 1875 K Marx

 


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