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Author Topic: Low CD4 opportunistic infection TB and PCP  (Read 7342 times)

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Offline Vancity

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Low CD4 opportunistic infection TB and PCP
« on: June 20, 2018, 10:04:47 pm »

 My partner tested positive last year October 2017 with a CD4 count of 30 and a high viral load . (not sure the exact number )
After starting his medications he got 2 opportunistic infections ( TB and PCP )
He has another 3-4 months of TB meds and still taking septra ? i think is what its called for the PCP ( or till his CD4 rises above 200 )

 After 5 months of using Triumeq his viral load dropped to undetectable in February 2018 ,only to rise again to 80 in march . and up again to 120 in april . In may his viral load was undetectable again . today his voral load is 70 june . this stresses me out . he see's his doctors monthly . my questions  ... are his 2  opportunistic infections have anything to do with his viral load not staying undetectable ?

 He also had lower back pain after starting the ARV's, tb medications .... had a few scans to find out he had an abcess in his lower back . it was drained and confirmed as TB . they have extended his tb medication for 3 months longer . does anyone know anything about TB as an opportunistic infection ?

 His white blood cells are kinda low also .

 there is a lot more i'm missing ...sorry i don't have his exact blood work numbers in front of me . he is handling all this really well . (me not so much )

 any tips or information would be great .  oh ....his CD4 of today is 120 and 24%


 please reply .

 
 

Offline Jim Allen

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Re: Low CD4 opportunistic infection TB and PCP
« Reply #1 on: June 21, 2018, 02:46:22 am »
Hiya

Sometime post starting treatment as HIV becomes suppressed and the immune system reawakens people can feel worse before they feel better, this is not due to the treatment but simply because the immune system has now woken up and is  starting to fight infections it had previously ignored   

As for the VL 120 copies. its a blip this can happen and as long as he's been adherent  to his medication he should be expecting it to be back down next time they measure it. Blips are not a concern unless it becomes a tend and that is highly unlikely

Jim
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Offline Vancity

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Re: Low CD4 opportunistic infection TB and PCP
« Reply #2 on: June 21, 2018, 03:30:26 am »
 let me simplify this question ......

 -Oct 2017 - tested poz . CD4  30  (high viral load) dont know the exact number .

  about a week after starting the ARV's he got 2 opportunistic infection's (TB and PCP)
 
 - February 2018 (after 4 months of ARV's) his viral load went undetectable <40

 - march 2018  viral load of 80

 - april 2018 viral load 120

 - may 2018 viral load was undetectable <40

 - june 2018 viral load 70 (as of today )

  he is still taking the TB meds and septra for the PJP . His CD4 was at 30 last October 
  today his CD4 is 120 and he is using triumeq .

  do you guys think these ups and downs of his viral load is because he is dealing with
  opportunistic infection's ?  i go to all his appointments for the HIV and TB ... i feel i'm 
  learning a lot . i just wish his viral load would stay undetectable .

  do you guys think when his CD4 hopefully rises 200-300 and he finished the TB and
  septra medications .....his body can focus on the HIV and improve ?

  I understand a blip is a one time thing ..... but seeing how his viral load was
  undetectable ... then when up , up again  and again . then undetectable and now 70 .
  is that normal ?

   thanks for any info .
 
   

Offline Jim Allen

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Re: Low CD4 opportunistic infection TB and PCP
« Reply #3 on: June 21, 2018, 03:55:34 am »
Quote
I understand a blip is a one time thing ..... but seeing how his viral load was
  undetectable ... then when up , up again  and again . then undetectable and now 70 .
  is that normal ? :)

Yes, I would not even call it a real blip. Mine is hovering between less than 20 to 48 copies, ever time its slightly up or down.

In terms of treatment clinically speaking under 50 is undetectable even though lots of labs can be more accurate than that and virological failure is mostly seen as a failure to sustain a person's viral load to less than 200 copies, also on the more recent studies into transmission I believe the UD threshold for transmission was set  at the higher virological failure threshold, so anything under 200.

So he had a single blip above 50 and below 200  its is not an issue and meaningless, no need for concern

cJim

https://www.poz.com/article/viral-blips-raise-risk-hiv-treatment-failure

Quote
  do you guys think these ups and downs of his viral load is because he is dealing with
  opportunistic infection's ?  i go to all his appointments for the HIV and TB ... i feel i'm 
  learning a lot . i just wish his viral load would stay undetectable

He is undetectable as explained above. Could the OI's cause a bit more variations in the results , sure but it could also not be the case and its irrelevant as its still UD/Virally suppressed or whatever term he prefereres.

Anyhow I hope he feels better soon and that you are getting the support you need as well.

Take it easy

Jim


« Last Edit: June 21, 2018, 03:57:44 am by JimDublin »
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Offline leatherman

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Re: Low CD4 opportunistic infection TB and PCP
« Reply #4 on: June 21, 2018, 05:22:47 am »
viral load reduction/suppression does not have to be a straight-line function going down with every test. During the first year for many people the VL (and cd4 count) can "bounce" around awhile until things "settle down" at UD.

Blips are usually considered 500 or more since the 200-point is what research uses to define successful viral suppression. Smaller "blips" or as we have dubbed them here as "microblips  "Undetectable" is a pretty inappropriate term as it doesn't really mean "completely undetectable" but "not detectable above a specific threshold" (such as <20 or <50 depending on the test and the lab)
leatherman (aka Michael)

We were standing all alone
You were leaning in to speak to me
Acting like a mover shaker
Dancing to Madonna then you kissed me
And I think about it all the time
- Darren Hayes, "Chained to You"

Offline Jim Allen

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Re: Low CD4 opportunistic infection TB and PCP
« Reply #5 on: June 21, 2018, 07:51:39 am »
OP

More important question is how is he feeling? How are you coping?

Jim
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Offline Vancity

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Re: Low CD4 opportunistic infection TB and PCP
« Reply #6 on: June 21, 2018, 04:55:32 pm »

 Thanks for the replies guys . For everything he has going on he is doing very well .

 Gained all his weight back ...taking his meds on time . for me its a rollercoaster up

 up and down . yesterday when he got his blood work back we both felt kinda

 disappointed that his viral load was up to 70 . Its seems a lot of personal stories

 i read on here , most people get to undetectable faster than 8 months . i just wish he

 can get to and stay undetectable .

 thanks guys .

 


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