Annual blood test result coming out bad =(

[Jackmydin]

Hi guys,

It's me back here again. So I just returned from the clinic and the blood work is bad.

4/8/21 - cd4 373. 11.42% ND
23/2/22 - CD4 346 12% ND
1/3/23 - cd4 215    15.29%.  VL 58049

Doctor still insist me to stick with my regular meds, and scheduled me for check up on July. I don't know if this is a good idea cause 58k vl doesn't looks like a blip to me =(

Anyone encountered similar situation like me? Or I need to change my med to second-line ART medication?

This is giving me such a big stress now 

[Jackmydin]

Add on- I do take my meds on time everyday. Only sometimes 10-20 minutes late but this can't be the reason I developed drug resistance right?

[Matths]

What are your current meds and what’s your treatment history?

[Jackmydin]

What are your current meds and what’s your treatment history?

I'm currently on atripla since 2017. I had 2 blips before for the past treatments, but not that high. Like a few hundreds.

[Jim Allen]

Add on- I do take my meds on time everyday. Only sometimes 10-20 minutes late but this can't be the reason I developed drug resistance right?

No

Hi guys,

It's me back here again. So I just returned from the clinic and the blood work is bad.

4/8/21 - cd4 373. 11.42% ND
23/2/22 - CD4 346 12% ND
1/3/23 - cd4 215    15.29%.  VL 58049

Doctor still insist me to stick with my regular meds, and scheduled me for check up on July. I don't know if this is a good idea cause 58k vl doesn't looks like a blip to me =(

Anyone encountered similar situation like me? Or I need to change my med to second-line ART medication?

This is giving me such a big stress now 

Well if it had been my lab results I wouldn't panic and ask the viral load to be checked again in two weeks.

[Jackmydin]

No
Well if it had been my lab results I wouldn't panic and ask the viral load to be checked again in two weeks.

Thanks Jim. I think ill be doing another viral load check next week since my last blood drawn is on 1st March.

But what if the viral load is still detectable? What should I do next?

[leatherman]

No
Well if it had been my lab results I wouldn't panic and ask the viral load to be checked again in two weeks.

I agree with both answers.
Modern meds have a long half-life and remain in our systems a long time. Actually, missing a rare dose or two (Remaining at least 95% adherent) will still keep successful treatment and not cause negative effects.

I went through a two year period with 3 major blips (2500, 7800, and even 59000). None of these results were back-to-back, and each time my vl returned to undetectable. Right after the 59k result, I had a genotype test done and my meds were found to still be effective. I never changed meds, and haven't blipped back up like that since.

But what if the viral load is still detectable? What should I do next?

have the genotype test done to find out if your meds are still working and this was an anomaly, or whether you need to switch meds.

[Jackmydin]

I agree with both answers.
Modern meds have a long half-life and remain in our systems a long time. Actually, missing a rare dose or two (Remaining at least 95% adherent) will still keep successful treatment and not cause negative effects.

I went through a two year period with 3 major blips (2500, 7800, and even 59000). None of these results were back-to-back, and each time my vl returned to undetectable. Right after the 59k result, I had a genotype test done and my meds were found to still be effective. I never changed meds, and haven't blipped back up like that since.
have the genotype test done to find out if your meds are still working and this was an anomaly, or whether you need to switch meds.

Thanks leatherman. That's some helpful info there. I'll ask my doctor on the genotype test done next visit. Sure scary as hell when I was told I went from ND to vl detected.

[leatherman]

Sure scary as hell

Next time, IF there is every a next time, rather than be scared just be leery.

Some facts:
HIV can replicate up to a trillion times a day
HIV is never eradicated by meds but it is reduced to a very low number
"undetectable" isn't really the same thing as "not detected at all". It just means at the lowest ability of the average test is 20
This small amount of HIV "hides" out in reservoirs, like lymph nodes and macrophages.
Occasionally, the small amount of HIV "wakes up" and starts replicating.
And that's why we take daily meds. When this wakened HIV starts going to town again, the meds in our blood targets all it's points of replication and, bing-o bang-o, we stay undetectable.

(fyi a potential "cure" strategy is called Kick and kill. If a medication could "wake up" ALL of this latent HIV (kick it out of hiding) and your meds destroyed it all that would be the holy grail, the cure.)

However, who's to say that just before you had blood work done, this latent HIV reactivated and replicated for a while as your HIV meds rained death and destruction on those pesky virions of HIV? In that case, your bloodwork WOULD show a viral load and maybe even a large one. Ack! What a shame you didn't know to take the test later in the day or even the next morning when your results would have been back to undetectable.

Quite simply, since cd4s can change + or - by 100 points a day, and the viral load can be negatively affected by "not very latent" latent HIV, a single "bad" test means nothing but re-checking within a couple weeks to a couple months to see if there has actually been a serious change.

So be leery/wary of a single bad result but don't jump to conclusions until and 2nd or 3rd bad test result.

btw, you'd have to have a 2nd bad test in a row for a genotype test. That test requires you to have a viral load to be able to test it's reaction to the meds.

[Jackmydin]

btw, you'd have to have a 2nd bad test in a row for a genotype test. That test requires you to have a viral load to be able to test it's reaction to the meds.

Just now the clinic just called. I'm being scheduled for another blood test next week for viral load.

[Matths]

You are doing all the right steps and clearly are on top of your game. Therefore, nothing to worry, even if you need to update your treatment regime. I would be scared too and hope that if I ever get in a similar situation someone reminds me that if you are actively engaged in your treatment plan and understand how it works, with the current treatment options you will be back to UD very soon. Keep us posted, best Matt

[Jackmydin]

You are doing all the right steps and clearly are on top of your game. Therefore, nothing to worry, even if you need to update your treatment regime. I would be scared too and hope that if I ever get in a similar situation someone reminds me that if you are actively engaged in your treatment plan and understand how it works, with the current treatment options you will be back to UD very soon. Keep us posted, best Matt

Thanks Matt. You are right, I shouldn't be over worried and follow what's instructed by the doctor. Great thanks to you, leatherman and Jim! Cheers

[Jackmydin]

I'm back.

This time after 3 months of monitoring, my viral load is back undetectable and my cd4 climbs back up to 300+, didn't have the chance to ask about the cd4 % but I'll ask about it next appointment.

Thanks guys for the great support. Especially the time I'm freaking out over my "blipped" result.

[numbersguy82]

I'm back.

This time after 3 months of monitoring, my viral load is back undetectable and my cd4 climbs back up to 300+, didn't have the chance to ask about the cd4 % but I'll ask about it next appointment.

Thanks guys for the great support. Especially the time I'm freaking out over my "blipped" result.

Fantastic news! I’m glad your numbers are back (even better than before) I haven’t seen a setback like that myself, so I can imagine how distressing it would be.

[Tonny2]

           ojo.             Congratulations!!… keep up the good work.. the secret to have control of the virus is discipline in taking your medication as ordered, and now that you are positive, you have to be more positive in the way that you live your life, your second chance to be a better person… I bet that it has to be a bit problematic to be tested once a year, but as I said, as long as you take your treatment as prescribed, you will be fine…hugs and please keep us posted. Now go and take control of your life again.

[kentfrat1783]

First off, how are you doing knowing it's back to UD?  Many times, we forget to see how we are doing mentally but that is key to me. 

Did your Specialist give any indication on what caused the blip or ideas on how to take your Rx in a more efficient manner. I know I took Atripla to start and had no issues but always took it at bedtime.

Are you staying hydrated? Could have you been going through a stressful time when it went up?  Were you on any other medications that could have caused it not be as effective.  They are always concerned that I take a multivitamin and they always warn me to not take it within 6 hours of each other (yes it's slightly less than that but i rough it up to 6 for my mind). 

Just hope you are feeling relieved now and wishing you the best.

[leatherman]

They are always concerned that I take a multivitamin and they always warn me to not take it within 6 hours of each other

What ARVs are you taking? Never heard of multivitamins being an issue to take with meds. Six hours seems like overkill; although I know sometimes food and/or antacids are contraindicated for 2.5 hrs either before or after meds.

[kentfrat1783]

I take Triumeq, and in reality, it's 2.5 hours before and 4 hours after (or the opposite combination) but I push it to 6 just to give myself a buffer (and easier to remember).  I have also learned they like it as far apart as normal to I just say 6 and keeps them happy.

It deals with the Dolutegravir as having an interaction with the Multivitamin.  I just know anytime I start going through my med list with my Dr’s or Pharmacist I say right after the Multivitamin that “I take them separate”.  I can see their eyes getting wide and then relaxing after that.

I just take the Multivitamin in the morning and the Triumeq at night to make things easier.

 

[leatherman]

If you take them too close together, they can cause Triumeq® to not work as well. Take Triumeq® either two (2) hours before or six (6) hours after you take your multivitamin, antacids, or other products containing magnesium, aluminum, iron, or calcium

Ah! I hadn't really paid attention that this was still a thing with some modern meds. Most of the earliest meds had strict time and/or food restrictions/obligations; but I haven't used anything with these restrictions in quite a while.

The issue is to have the medications properly digested in a timely manner. Some meds require food which helps activate stomach acid. Other meds don't need the food requirement but can't have minerals like iron, calcium or magnesium neutralize digestive acid which would cause less absorption of those ARVs.

[kentfrat1783]

Most of the earliest meds had strict time and/or food restrictions/obligations

So does this count me as an old timer?  LOL  Just being funny.

The Triumeq is doing welll for me, I don't mind a few restrictions, and it's still only a pill at night so not a big deal.  It fits into my life so no real big down side.

[Jackmydin]

First off, how are you doing knowing it's back to UD?  Many times, we forget to see how we are doing mentally but that is key to me. 

Did your Specialist give any indication on what caused the blip or ideas on how to take your Rx in a more efficient manner. I know I took Atripla to start and had no issues but always took it at bedtime.

Are you staying hydrated? Could have you been going through a stressful time when it went up?  Were you on any other medications that could have caused it not be as effective.  They are always concerned that I take a multivitamin and they always warn me to not take it within 6 hours of each other (yes it's slightly less than that but i rough it up to 6 for my mind). 

Just hope you are feeling relieved now and wishing you the best.

yea man. Im ok now, quite relieved actually knowing my meds are still working. Well that is what my doc suggested too. not to mix other meds with my atripla. the only incident that would be reasonable for the blip is because i was on fungal medication (oral, twice a day dose). And that caused my liver to start giving crazy readings, coincidentally that's the moment i had my blood drawn for annual cd4 test. Hence the detected viral load and cd4 drop. I also have to drop my other supplements such as zinc and fish oil. I was told to take zinc for my Telogen effluvium condition ( hair thinning issue) , but once my liver stats are back to normal, my hair grows back and everything is normal. So i guess the main culprit would be the oral fungal medication that i took, which somehow messed up with atripla.

[kentfrat1783]

Well that is what my doc suggested too. not to mix other meds with my atripla.

Doing a very basic search I bet it was an interaction with the Efavirenz that is in the Atripla. Then again the reations were more related to heart issues then your viral load but once our bodies get off kilter other things will could happen. 

But you are back to normal so we just need to keep moving forward and I hope you have a great week.

[Jackmydin]

Yea best to take it as a lesson learnt and looking forward. Have a nice weekend for you all too.