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Author Topic: First set of numbers  (Read 5890 times)

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Offline spacebarsux

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First set of numbers
« on: February 14, 2011, 08:10:50 AM »
Dear All,

I just picked up my first set of numbers from the lab. Any insight would be very helpful to me. I am going to take them to my doc in a couple of days- which is when the appointment is scheduled.

HIV-1 RNA Quantitative- 39161 copies/ml
CD4- 754 / 34%
CD3- 80%
Absolute T- Cell count 1780.

Many many thanks in advance.
Infected-  2005 or early 2006; Diagnosed- Jan 28th, 2011; Feb '11- CD4 754 @34%, VL- 39K; July '11- CD4 907@26%,  VL-81K; Feb '12- CD4 713 @31%, VL- 41K, Nov '12- CD4- 827@31%

Offline Matty the Damned

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Re: First set of numbers
« Reply #1 on: February 14, 2011, 01:33:51 PM »
Hi Space,

Those are pretty good numbers. Your CD4 count is well in the normal range which means you're not likely to get ill.

Remember that these sorts of tests are about trends over time so you need to get a few done to really know what's happening to you.

But those are good numbers. Your doctor will most likely want to discuss treatment options with you.

MtD

Offline drewm

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Re: First set of numbers
« Reply #2 on: February 15, 2011, 12:19:07 AM »
Great numbers and Matty is right, it's more about the trend.

Hang in there :-)
Diagnosed in  May of 2010 with teh AIDS.

PCP Pneumonia . CD4 8 . VL 500,000

ATRIPLA - VALTREX -  FLUOXETINE - FENOFIBRATE


Numbers consistent since 12/2010 - VL has remained undetectable and CD4 is anywhere from 275-325

Offline spacebarsux

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Re: First set of numbers
« Reply #3 on: February 15, 2011, 12:40:01 AM »
Thanks very much MtD and drewm. I haven't even met my doc yet. I spoke to him over the phone and while he said the CD4 count was good, he also said that the new Govt. of India HIV Treatment guidelines say that one should be put on treatment as soon as one is diagnosed to bring the VL to UD.

Is this standard practice in the States and Europe as well? I'm still coming to grips with being positive and don;t really want to jump on treatment right away.

In any case I will be meeting him tomo. He said he needs to examine me for other infections first.

 
Infected-  2005 or early 2006; Diagnosed- Jan 28th, 2011; Feb '11- CD4 754 @34%, VL- 39K; July '11- CD4 907@26%,  VL-81K; Feb '12- CD4 713 @31%, VL- 41K, Nov '12- CD4- 827@31%

Offline Matty the Damned

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Re: First set of numbers
« Reply #4 on: February 15, 2011, 01:32:14 AM »
Thanks very much MtD and drewm. I haven't even met my doc yet. I spoke to him over the phone and while he said the CD4 count was good, he also said that the new Govt. of India HIV Treatment guidelines say that one should be put on treatment as soon as one is diagnosed to bring the VL to UD.

Is this standard practice in the States and Europe as well? I'm still coming to grips with being positive and don;t really want to jump on treatment right away.

In any case I will be meeting him tomo. He said he needs to examine me for other infections first.

 

Basically there are two schools of thought on when to commence HAART aka Highly Active Anti Retroviral Therapy.

Some believe in the "hit hard, hit early" approach. Commence treatment as soon as possible after diagnosis without reference to the initial viral load and CD4 counts. This is an attempt to ensure that your VL is suppressed quickly and there isn't any damage to your immune system.

Others maintain that it is wiser to wait until one's CD4 count drops to a particular level (usually 500 CD4s or 350 CD4s depending on where you are) and then commence treatment. This prevents people having to experience potentially unpleasant side effects from the medications before it's really necessary.

There is merit to both approaches. It's really a matter of what you feel most comfortable about. Starting medications before you're ready can be problematic. Adherence is important and can be more difficult than you think. That said, for many people good adherence is just a matter of a little self discipline and modern medications have relatively low toxicity. You don't want to wait until you've sustained immune system damage if you can avoid it.

Ultimately this is something you and your doctor need to work on together. Be prepared to tell your doctor how you feel, particularly if you're uncomfortable about a certain course of treatment. That said, it's important to remember that your doctor knows what he's doing and you should take his advice very seriously. HIV is not a disease to treat dismissively.

Keep us posted. :)

MtD

Offline spacebarsux

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Re: First set of numbers
« Reply #5 on: February 15, 2011, 03:13:26 AM »
Ok got it, thanks.

By the way, my doc also scolded me for wasting time surfing the net on this. He said leave it to the experts. Will keep you posted.
Infected-  2005 or early 2006; Diagnosed- Jan 28th, 2011; Feb '11- CD4 754 @34%, VL- 39K; July '11- CD4 907@26%,  VL-81K; Feb '12- CD4 713 @31%, VL- 41K, Nov '12- CD4- 827@31%

Offline Matty the Damned

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Re: First set of numbers
« Reply #6 on: February 15, 2011, 03:23:08 AM »
Ok got it, thanks.

By the way, my doc also scolded me for wasting time surfing the net on this. He said leave it to the experts. Will keep you posted.

Well participating in these forums and checking the AIDSmeds website is not a waste of time. We are the leading HIV/AIDS presence on the internet. It's more than just getting information, it's about being part of a community.

You'll find, as time goes on, that having the support of your own kind is very important in coming to terms with HIV.

:)

MtD

Offline spacebarsux

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Re: First set of numbers
« Reply #7 on: February 15, 2011, 03:56:23 AM »
Yes, i apologise for the way that came across. This site has been my only support since i was diagnosed. As i said before i have not yet shared this information with anyone yet.

So even though i don;t know any of you and you are on the other side of the globe- you are like my new family now. You have no idea how much i appreciate the words/support of everyone on this site.
Infected-  2005 or early 2006; Diagnosed- Jan 28th, 2011; Feb '11- CD4 754 @34%, VL- 39K; July '11- CD4 907@26%,  VL-81K; Feb '12- CD4 713 @31%, VL- 41K, Nov '12- CD4- 827@31%

Offline Matty the Damned

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Re: First set of numbers
« Reply #8 on: February 15, 2011, 04:07:57 AM »
Yes, i apologise for the way that came across. This site has been my only support since i was diagnosed. As i said before i have not yet shared this information with anyone yet.

So even though i don;t know any of you and you are on the other side of the globe- you are like my new family now. You have no idea how much i appreciate the words/support of everyone on this site.

Space,

You don't have anything to apologise for, I know you were only relating what your doctor has said.

I was more concerned that you might think you shouldn't come here because your doctor disapproves of you seeking solace on the internet. Doctors are good for the medical aspects of one's predicament but that's only part of the answer. We need to be able share with others who have our experiences in common.

No matter where we might be on the planet. :)

Take care,

MtD

Offline newt

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Re: First set of numbers
« Reply #9 on: February 15, 2011, 06:53:37 AM »
Quote
new Govt. of India HIV Treatment guidelines say that one should be put on treatment as soon as one is diagnosed to bring the VL to UD.

Hello spacebar

I believe that the Indian HIV treatment guidelines were last updated in 2007. Here's a link (to a biggish PDF file):
http://www.nacoonline.org/upload/Policies%20&%20Guidelines/1.%20Antiretroviral%20Therapy%20Guidelines%20for%20HIV-Infected%20Adults%20and%20Adolescents%20Including%20Post-exposure.pdf

These do not say treat immediately.

They say:

Asymptomatic or mild symptoms - Treat if CD4 <200
Advanced symptoms - Consider treatment if CD4 <350 and initiate ART before CD4
drops below 200
Severe symptoms - Treat irrespective of CD4 count

This is pretty much in line with international recommendations.

India introduced a new policy in June 2010 for immediate treatment of children with HIV on diagnosis, an altogether different thing.

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

Offline drewm

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Re: First set of numbers
« Reply #10 on: February 15, 2011, 01:44:49 PM »
It's always best to listen to your doc, he should be the expert. Having said that, the folks here, many who have been here longer than I have and fighting this fight longer than I have may have some great suggestions for questions and other things to look at.

Anyway, it sounds like you are on the right path so hang in there try not to panic.
Diagnosed in  May of 2010 with teh AIDS.

PCP Pneumonia . CD4 8 . VL 500,000

ATRIPLA - VALTREX -  FLUOXETINE - FENOFIBRATE


Numbers consistent since 12/2010 - VL has remained undetectable and CD4 is anywhere from 275-325

Offline newt

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Re: First set of numbers
« Reply #11 on: February 15, 2011, 04:23:56 PM »
It's also good to read guidelines (or a summary of them) for your area, then you can decide if you doc is being slack, conservative, evidence based, proactive, imaginative, holistic, wacky, extra smart, casual or just plain dumb etc. Docs have opinions, often sound and informed, but, unfortunately, sometimes not so well thought out. In my book a good doctor should be able to clearly and robustly justify any option/direction s/he offers/gives me.

- matt the newt

Now playing: Battlestar Galactica, final season on the DVD (2 episodes to go)
"The object is to be a well patient, not a good patient"

Offline spacebarsux

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  • Survival of the Fittest
Re: First set of numbers
« Reply #12 on: February 17, 2011, 03:58:51 AM »
So i met my doc this morning. He was quite supportive and said that he needs to run another bunch of blood tests pluc Chest X ray to see how lmy body is doing. After he looks at those results he is going to discuss treatment options with me.

Just being in the hospital around so many poz peole was quite terrifying though. I couldn't relate to anyone there! Not one!
Infected-  2005 or early 2006; Diagnosed- Jan 28th, 2011; Feb '11- CD4 754 @34%, VL- 39K; July '11- CD4 907@26%,  VL-81K; Feb '12- CD4 713 @31%, VL- 41K, Nov '12- CD4- 827@31%

Offline spacebarsux

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Re: First set of numbers
« Reply #13 on: February 18, 2011, 08:18:24 AM »
Disclosure issues. LONG POST- sorry

Hi all,

First off- thanks a tonne for all the tips you've given me. It means a lot.

I just wanted your advice on disclosure etc.

I come from like an urban- upper class ort of Indian family. So its not like they are totally misinformed about sexuality issues and HIV. But there is still a lot of prejudice in their mindset. I tested the waters several times in the past by bringing up gay issues on the dining table (and other than my sister) my parents just sounded like complete homophobes which is why i never came out to them. For that very reason a lot of my close friends also don't  know that i am gay. thankfully, i do have some very close gay friends who i might share the news with in due course.

I am finding it almost excruciating keeping this bottled up inside of me. Sometimes i feel like i am going to burst.

On top of that, I live with my parents (which is fairly common in India). How am i going to hide meds etc etc. from them? Plus they can totally tell that i am not acting myself lately.

I feel like i am stuck inan awful situation where i need them but can't tell them. I know that if and when i disclose- in the long run they will be there for me. But, if i tell them now- i think they will just have a heart attack. (quite literally)

One option is that i move out and then figure things out. I know i cant hide this forever. just any tips would help. many thanks
Infected-  2005 or early 2006; Diagnosed- Jan 28th, 2011; Feb '11- CD4 754 @34%, VL- 39K; July '11- CD4 907@26%,  VL-81K; Feb '12- CD4 713 @31%, VL- 41K, Nov '12- CD4- 827@31%

Offline Andy Velez

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Re: First set of numbers
« Reply #14 on: February 18, 2011, 09:16:19 AM »
Space, just for now I would suggest that you not rush to do anything about telling your family. Although you are "bursting" with feelings and wanting someone to talk with, I urge you to take some time. The thing about disclosing is that once you have done it there is no do-over and you have to be prepared to accept the consequences.

You are worrying about having medications around when at this point it is not even certain you will be going on meds. You may find discussing your thoughts and feelings with your doctor to be helpful. He will certainly have experience with many others who have been in your same situation. Read our lesson on disclosure if you haven't already done so. See what it contains that might be helpful to you.

Although you did not feel there was anyone you could relate to that may change. Find out if there are any support groups available. Dealing with coming out sexually as well as about HIV status is a big one, but many, many others have gotten through it and you will too. If it's any comfort to you, the fears you express are very familiar ones here.  

Meantime you are always welcome here to talk about what's on your mind in a safe setting. You are already finding how informed and supportive members can be here.

As a means of expressing some of your thoughts and feelings you might consider keeping a journal during this time. Do it in a safe place on your computer or elsewhere where you can speak truthfully. In future times you may find it valuable to look at as you realize that you got through what seemed impossible to manage at the time. Just a suggestion. As with any suggestions of mine or others, use your instinct as to what feels right for you.

Cheers. 
« Last Edit: February 18, 2011, 09:21:31 AM by Andy Velez »
Andy Velez

Offline spacebarsux

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Re: First set of numbers
« Reply #15 on: February 19, 2011, 01:46:27 AM »
Thanks a lot for the advice Andy. I wiill speak to my doctor and sound out all my concerns and fears. I am also going to get professional counselling. After that i MAY CONSIDER disclosing it to my closest friend. But i will only do so after giving due thought to all possible ramifications.  I know i can trust my closest friends- but then again i have all sorts  (possibly illogical fears) such as- what if we have a falling out - would he reveal my status to others to spite me etc.

But thanks again. I am already feeling better :)
Infected-  2005 or early 2006; Diagnosed- Jan 28th, 2011; Feb '11- CD4 754 @34%, VL- 39K; July '11- CD4 907@26%,  VL-81K; Feb '12- CD4 713 @31%, VL- 41K, Nov '12- CD4- 827@31%

Offline Matt39

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Re: First set of numbers
« Reply #16 on: February 20, 2011, 04:31:29 AM »
Dear All,

I just picked up my first set of numbers from the lab. Any insight would be very helpful to me. I am going to take them to my doc in a couple of days- which is when the appointment is scheduled.

HIV-1 RNA Quantitative- 39161 copies/ml
CD4- 754 / 34%
CD3- 80%
Absolute T- Cell count 1780.

Many many thanks in advance.

Hi Space

First of all, at the risk of being boring I am going to repeat some of the advice already given but first off let me deal with your numbers:

1. They are exceptionally good - indeed there are millions of 'HIV' negative folks who don't have such good CD4 or percentage numbers as you have right now.

2. Frankly, I am astonished your Doctor could even be suggesting any start on Anti-Retroviral Treatment at this stage.
Let us review guidelines with the USA and Europe as they are most pertinent:
Unless you have any relevant immune deficiency illnesses, which you appear not to have, then even in the USA the National Institutes of Health Panel advice is to consider starting when your CD4 is still at about 500.
In Europe, the advice is as follows:
You should consider starting HAART when your CD4 drops below 350 *or* the percentage drops below 14%. You should also consider starting HAART earlier *if* you are coinfected with Hep B and/or C, you have clear risks of cardivascular disease or are over 50.

So, unless you meet any of those other markers for early start (Hep B or C infection/cardiovascular disease risks/over 50 years of age) you simply are not in a category to start HAART on your numbers.

The *average* drop in CD4 numbers per year after diagnosis is between 50-70, so unless your numbers change radically from the norm you have at least 2-3 years to get yourself accustomed to the idea of meds.

Now here is the good news about that: World wide Double-blind, placebo controlled trials clinic trials started last year in over 30 countries called 'START'. These world-wide coordinated trials will provide the *first* scientific proof or otherwise of the benefits *or not* of starting HAART earlier than 350 CD4/14%+.
The first reports of that trial will start to be published in 2013.
The 'START' trials are crucial to providing real scientific evidence one way or another on the benefits and dangers of early start, since there are mounting cases of severe ill-health from some of the toxicities of ARVs.
Read Sean Strub over at Poz.com blogs for example, and his articles there in 2010 about severe bone mineral density loss (leading to a massive increase in serious breaks and fractures among relatively young men) in which all ARVs are implicated, but which Proease Inhibitors and Tenofovir (which is dispensed alone and in Atripla and Truvada) are the worst culprits.
*Before* you start meds, take the advice of Sean Strub and those of us with a similar experience: insist you are referred for a full DXA Bone Mineral Density Scan now or at the start of treatment, and then yearly after, to measure any bone mineral loss.

Other than that, it is crucial now that you pay attention to your body's own 'voice' about how it is doing, try to achieve a balanced whole food diet, regular sound sleep patterns and as much activity to reduce stress as you can - the more simple, straightforward techniques for meditation can be immensely beneficial. Brisk walking, light-jogging (or swimming) are excellent exercise - whatever anyone tells you, going to the 'gym' and pumping weights is not necessary unless it is something you already do. If you don't, then don't feel under any pressure to do that. Remember, everything *in proportion* doing anything too much or obsessively is can do more harm than good.
Make sure you spend time on those activities that you enjoy, that make you feel good.
All these things will actually enhance your immune system and keep it working well for longer.

Good luck
« Last Edit: February 20, 2011, 04:41:51 AM by Matt39 »

Offline spacebarsux

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Re: First set of numbers
« Reply #17 on: February 20, 2011, 08:22:27 AM »
Thanks Matt. i will defo look in to pro's and con's of starting meds in greater detail.
Infected-  2005 or early 2006; Diagnosed- Jan 28th, 2011; Feb '11- CD4 754 @34%, VL- 39K; July '11- CD4 907@26%,  VL-81K; Feb '12- CD4 713 @31%, VL- 41K, Nov '12- CD4- 827@31%

Offline hope4love

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Re: First set of numbers
« Reply #18 on: February 28, 2011, 06:00:15 AM »
Hi Space,
I am in Bangalore and been HIV + for about a year and on medications. Your CD4 numbers are very good and as of now you do not need to start medications. I understand its difficult in India to be gay and HIV positive and I am have been dealing the same issues. I hope over a period of time you will learn more and know the technique of managing HIV. All the best.
Jan 2009 - Sero Negative
Jan 2010 - Sero Positive
               CD4 - 275, VL - 18,000
Oct 2010 - CD4 - 241, Started - Vonavir; Oct 2011 - CD4 - 474;Jan 2012 - CD4-620; Aug 2012-CD4-600, VL- UD; Jan 2013 CD4-493, VL-72 IU/ml   (Blip)

Offline spacebarsux

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Re: First set of numbers
« Reply #19 on: March 12, 2011, 02:05:35 AM »
Hi guys,

Ok so I am just going insane trying to work out the pros and cons of both the 'hit hard, hit early' or the 'wait and see' approach. I mean, isn't the doctor supposed to weigh the pros and cons of both in your given situation and tell you what's best for you?

Anyway, given my numbers (despite my high VL of 39K) my doc told me, in his opinion, it is best to wait. He told me to come back in 6 months (I said NO- I will be back in 3!!). I did tell him i hate the thought of just waiting- knowing that this virus is multiplying unchecked. But then he said, what you have been sayin Matt- about long term toxicities especially to the liver and kidneys etc.! He also made them sound much scarier than i thought.

So my mind is all over the place now.
Infected-  2005 or early 2006; Diagnosed- Jan 28th, 2011; Feb '11- CD4 754 @34%, VL- 39K; July '11- CD4 907@26%,  VL-81K; Feb '12- CD4 713 @31%, VL- 41K, Nov '12- CD4- 827@31%

Offline Matt39

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Re: First set of numbers
« Reply #20 on: March 12, 2011, 01:09:14 PM »
Hi guys,

Ok so I am just going insane trying to work out the pros and cons of both the 'hit hard, hit early' or the 'wait and see' approach. I mean, isn't the doctor supposed to weigh the pros and cons of both in your given situation and tell you what's best for you?

Anyway, given my numbers (despite my high VL of 39K) my doc told me, in his opinion, it is best to wait. He told me to come back in 6 months (I said NO- I will be back in 3!!). I did tell him i hate the thought of just waiting- knowing that this virus is multiplying unchecked. But then he said, what you have been sayin Matt- about long term toxicities especially to the liver and kidneys etc.! He also made them sound much scarier than i thought.

So my mind is all over the place now.

Your doctor sounds *very* sensible to me (with the one proviso being that here in the UK 3 monthly blood tests are the norm) and he is adhering to proven clinical studies about when to consider starting meds.
39k is *not* repeat *not* a high viral load. Even among conservative HIV doctors that is not considered even half way to high.
As far as your CD4 cell count is concerned, it is necessary to repeat the importance of the *percentage* as well as the whole numbers.

Your anxiety is not uncommon but you really do need to get support for your emotional and psychological well-being because persistent (ie chronic) anxiety will itself cause your health to decline and is a self-fulfilling prophecy.

You need with that support and turn this around so that you see yourself as *fortunate* to have such good numbers.

You should also pay much more attention to your other blood results - eg Blood Sugar, Cholesterol, Liver and Kidney function etc - and if they are good/within normal, then you are even more fortunate.

Good luck

Offline drewm

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Re: First set of numbers
« Reply #21 on: March 12, 2011, 02:16:06 PM »
Dude, listen to your doc. I'm with Matty on this. Your VL is NOT high but I am going to tell you that the stress you are experiencing in dealing with this is very real, very understandable and MUST BE DEALT WITH. Let your doc do the doctoring...take your questions to him and LET HIM MAKE THE CALL. That's why you hired him, right?

You can read too much into numbers, other peoples diagnoses and side effects and the beat goes on. Your doc is focusing on YOU, YOUR NUMBERS and YOUR RESISTANCE etc. Let him work  :)

**THE CAPS does not mean I am yelling at you, I'm NOT, I just want you to listen and sometimes it's hard to do when you are reading into this stuff and forming opinion based on a self-fulfilling prophecy.***

(((HUGS)))
Diagnosed in  May of 2010 with teh AIDS.

PCP Pneumonia . CD4 8 . VL 500,000

ATRIPLA - VALTREX -  FLUOXETINE - FENOFIBRATE


Numbers consistent since 12/2010 - VL has remained undetectable and CD4 is anywhere from 275-325

Offline coolstone25

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Re: First set of numbers
« Reply #22 on: March 14, 2011, 12:11:31 PM »
For your information: a few facts to consider.
=====================

Auch ohne Symptome, hohe Viruslast oder niedrige CD4-Zahl:

HIV-Therapie noch viel früher starten?

BERLIN – Allem Fortschritt zum Trotz bleibt bei der HIV-Therapie noch eine Reihe von Aufgaben ungelöst: Wann ist der optimale Zeitpunkt für den Start? Wodurch lässt sich die Zahl der Spätdiagnosen senken, und wie kann man durch Therapie neuen Infektionen vorbeugen?

Es steht wohl außer Zweifel, dass die hochaktive antiretrovirale Therapie (HAART) die Ausbreitung der Viren bremsen kann. Je niedriger die Viruslast, desto geringer wird die Übertragungswahrscheinlichkeit, bei einem Wert unter 500 Kopien/ml liegt sie nur noch bei 1/100.000, erklärte Priv.-Doz. Dr. Jan van Lunzen vom Universitätsklinikum Hamburg-Eppendorf bei den 12. Münchner AIDS-Tagen.

Könnte man sicherstellen, dass 90 % der Infizierten effektiv behandelt würden, könnte dadurch wahrscheinlich sogar die Epidemie zurückgedrängt werden. Außerdem bedeutet eine bessere Therapie oft auch eine größere Bereitschaft, sich testen zu lassen – ein Effekt, den Infektionsmediziner sich von der HIV-Risikoklientel dringend wünschen.

Bis zu 50 % wissen nichts von ihrer Infektion

Denn noch immer wissen schätzungsweise 40 bis 50 % der Infizierten in der EU nichts von ihrer Infektion (Deutschland: 25 bis 30 %); entsprechend spät startet die Therapie. Weltweite Untersuchungen haben ergeben, dass das Gros der HIV-Infizierten erst eine hochaktive antiretrovirale Therapie erhält, wenn die CD4-Zellen schon unter 200/μl gefallen sind, nicht selten sogar erst bei unter 100/μl. Die European AIDS Clinical Society wird demnächst eine Liste von Indikatorkrankheiten vorlegen, die zum Anlass für einen HIV-Test genommen werden sollen. Ein später Therapiestart verschlechtert die Erfolgschancen erheblich. Denn eins steht fest: Je niedriger der CD4-Nadir, also der jemals gemessene Tiefststand, desto schlechter erholt sich das Immunsystem unter der HAART. „Auch gut startende Patienten erreichen nicht das Normalniveau“, so Dr. van Lunzen. Aber sie steigen höher als Patienten mit schlechten Ausgangswerten.

Wer früh mit der Therapie beginnt, hat auch weniger unter Nebenwirkungen zu leiden, wie die HIV Outpatients Study (HOPS) ergab. Patienten, die bei Therapiebeginn noch mindestens 500 CD4- Zellen/μl aufwiesen, erlitten 70 % weniger renale und 30 % weniger neuropathische Nebenwirkungen und nur halb so viele Lipoatrophien. Interessanterweise hängt nicht nur das Risiko, an AIDS zu erkranken, sondern auch das für andere HIV-Begleiterkrankungen vom CD4-Ausgangswert ab. Todesfälle durch nicht mit AIDS assoziierte Infektionen und Krebserkrankungen sowie durch Leberversagen sind bei „Schlechtstartern“ signifikant häufiger, sagte Dr. van Lunzen.

Möglicherweise sollte man mit der Behandlung sogar früher beginnen, als es die Leitlinien heute vorsehen. Denn das geltende Dogma, den Startschuss für die Therapie zu setzen, wenn Symptome auftreten oder bei hoher Viruslast (> 50.000 bis 100.000 Kopien/ml) oder niedriger CD4-Zellzahl (< 350/μl), verfehlt anscheinend den Zeitpunkt für ein optimales Ergebnis.

Dr. Manuela Arand

Offline Tim Horn

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Re: First set of numbers
« Reply #23 on: March 14, 2011, 03:28:31 PM »
Coolstone:

Instead of posting entire passages in German from an unreferenced text -- the second time you've done so today -- it would be better for you to summarize, in English, what you find so interesting about it, how it relates to the thread in question and provide a hyperlink to the original source. And not for nothing, but I'm not seeing anything in this particular passage regarding the potential benefits of starting ARV therapy that hasn't been noted in numerous other English language texts.

Tim
« Last Edit: March 14, 2011, 03:32:29 PM by Tim Horn »

Offline coolstone25

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Re: First set of numbers
« Reply #24 on: March 14, 2011, 06:11:14 PM »
Dear Tim,

You are right! Here we go:
Space bar sux (and for others interested in numbers and starting ART)

The relevant part that struck me, about your specific case:
"Patienten, die bei Therapiebeginn noch mindestens 500 CD4- Zellen/μl aufwiesen, erlitten 70 % weniger renale und 30 % weniger neuropathische Nebenwirkungen und nur halb so viele Lipoatrophien."
is that if your CD4 count is still atleast at 500 or more, according to the out patient study they have outlined, the side effects are about 70% lower in reference to nephrotoxicity; 30% lower in neuropathic side effects and 50% lower in terms of lipodystrophy.
Also to note, in quite a few other studies, starting treatment earlier has shown a lot of advantages, in terms of fewer opportunistic infections, better preserved immune systems and pool of bone marrow stem cells, but most notably, starting ART sooner has shown greater correlation to longer life expectancy and higher survival rates among normal progressors without any advantageous genes. Even starting ART in the acute phase has shown to give high potential benefits, upto 72 weeks after stopping ART.

Your viral load is 40,000 copies/ml;
the normal for an average progressor, 6 months to a year after in to an infection, when one is in the clinical latency phase is 20,000 copies to 60,000 copies. Your count of 40,000 is on the higher side of the percentile. However your CD4 count is healthy. The article hence states, it's a dilemma and a matter of judgement call;

Your doctors will take in to account the trend of the virus, the virus genotyped to resistance, your genes, etc to understand the progression of your disease before prescribing the meds.

-Coolstone

 


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