Numbers that aren't logical, do I need another data point?

[qrky]

I tested pos back end of December '06 and have had numerous CD4 tests since then.  I started out with 395 and 32% and abandoned that doctor when he said (without offering a resistance test) I should be on Atripla.  Over the next few months the CD4 count has dropped steadily while the percentage has not. 

1/17  CD4 395 (32%)
3/24  CD4 350 (can't recall percentage, I think 30??)
4/30  CD4 292 (31%)
5/24  CD4 212 (27%) <--- Different hospital, I moved to NYC
6/21  CD4 252 (29%)

None of the three doctors can offer an explanation about why the percentage is totally out of proportion with the count.  At the same time it seems given the blip upward in both on last test just 3-1/2 weeks apart it might be wise to get one more data point in a couple of weeks to make sure it doesn't keep trending up percentage wise since as far as I understand it my CD4 percentage is double the area where bad things happen.  Not only do meds concern me from a financial standpoint but also a functionality standpoint -- for my work I need to be mentally very functional.  They've given me a scrip for Atripla which I have not yet filled.

-doug

[keyite]

I've experienced a decline too, even though CD4% has been relatively stable, and like you have been wondering - given relatively high CD4% - when it would be recommended to start meds. I actually posed a question along those lines on The Body: http://www.thebody.com/Forums/AIDS/Labs/Archive/Treatment/Q183556.html

I totally understand your dilemma but if I was in your shoes I'd be worried about CD4 slipping below 200 and thereby significantly increasing the risk of contracting OIs, even though you have a very good CD4%. Do you also have numbers for your viral load?

[qrky]

Over 100k still.

-doug

[Bucko]

Numbers fluctuate, Doug. ordinarily I say not to sweat bumps and dips.

But with everything hovering so close to 200, I'd go on meds, myself.

Your life is much more important than any job, no matter how brilliant or well-paying.

Brent
(Who knows all about jobs)

[sdcabincrew74]

I am no doctor and just try to learn all I can about this little friendly virus.  However, if I were in your shoes, with your percent so high, I would get another data point in four weeks.  However, I would also start bactrium to avoid PCP.  It is a real bitch and if you think meds will screw with your job, trying being in the hospital with PCP .... it takes MONTHS to recover from that.  So, if you are indeed going to wait on meds, I would start preventative antibiotics to be on the safe side.

Lastly, atripila is not the only option out there ... reyetaz and truvada are not known to cause a lot of brain fog ....

[newt]

Hello

welcome to the wonderful world of living with flight nos

1. CD4 counts are accurate to +/- 50.

2. CD4 counts can vary by time of day. whether you have a cold, slept well etc.

3. CD4 counts can vary by lab.

4. CD4 count or CD4% can show when to consider treatment.  If one is bad and the other good pay attention to the bad.

5. Frequent CD4 counts don't give you more information, you can get a +/-100 count testing on consecutive days...

Your infection is new so I wouldn't rush to go on meds, I would get another count in 2-3 months. The count might improve, and the CD4% is good.   On the other hand, starting meds (or PCP prophylaxis) is a fair decision if you decide you want to now, some people need meds straight away/within a year, their bodies jus don't deal well with the virus and/or they feel it's safer.

Standard first-line therapy (ie no resistance concerns) is 2 nukes plus either a (boosted) PI or an NNRTI.  There are many choices.  Atripla's a bomb, very effiicient...  I personally agree with the clear head thing being v important, which is why I chose a PI based combo.  But some people can pop Atripla like sweeties and have no side effects.  The side effects thing, it's very individual.

Good luck

- matt

[Tempeboy]

Hey man,

If I had my time again, I would have started with a count over 300.  Your changing numbers might indicate a concurrent infection ie another sti.  A full physical and sexual health screen could tell you.

There are a number of once daily regimes that don't include efavirenz.  Link below to an article on changing treatment - but it covers alot of important things to consider when starting.

http://www.sfaf.org/beta/2006_sum/switching.html

treat timely, treat well.

[dtwpuck]

I would go on meds too. 

If you are worried about the mental side effects of Atripla and how it would effect your job performance, tell your doctor to choose a different combo.  Atripla is very effective, but it's not the only choice.  Remember... a doctor is not there to dictate, but to give you choices.  It's your body and your life.   But, don't waste precious time just because you have only been given one choice.  Your numbers are not improving.

[AustinWesley]

I tested pos back end of December '06 and have had numerous CD4 tests since then.  I started out with 395 and 32% and abandoned that doctor when he said (without offering a resistance test) I should be on Atripla.  Over the next few months the CD4 count has dropped steadily while the percentage has not. 

1/17  CD4 395 (32%)
3/24  CD4 350 (can't recall percentage, I think 30??)
4/30  CD4 292 (31%)
5/24  CD4 212 (27%) <--- Different hospital, I moved to NYC
6/21  CD4 252 (29%)

None of the three doctors can offer an explanation about why the percentage is totally out of proportion with the count.  At the same time it seems given the blip upward in both on last test just 3-1/2 weeks apart it might be wise to get one more data point in a couple of weeks to make sure it doesn't keep trending up percentage wise since as far as I understand it my CD4 percentage is double the area where bad things happen.  Not only do meds concern me from a financial standpoint but also a functionality standpoint -- for my work I need to be mentally very functional.  They've given me a scrip for Atripla which I have not yet filled.

-doug

Hey Doug,

Your % is good.   The VL is pretty high and likely wreaking havoc on your system.   I was scared to death of meds, but I have no side effects at all.   The first week I had very minor issues, but wasn't a big deal.

I'm on Sustiva/Truvada which is the same as Atripla.   The majority of my friends don't have all these horror stories about side effects either and are physically and mentally healthy.

While I can really only speak for myself I'll tell ya my energy level has jumped up dramatically and I feel about 10 years younger now after 4 months on meds.  I may switch to Atripla once this RX runs out.   

Personally, my feeling if I were in your shoes would be to go ahead and start meds sooner rather than waiting it out too long.   Your doc will likely tell you to take Atripla at night on an empty stomach when starting.   I went to Undectectable w/in the first month and am due for 5 month ck in August, but I anticipate my CD4's will have improved drastically by then.

Hang in there!  You will be fine!   

Wesley

PS:   Uh, yeah get a genotype!   I'd be shopping for a new doc if mine hadn't done the resistance testing too.   You should know where you stand before starting meds.