Suggestions needed

[Hope4life]

First of all thanks a lot you all for making this platform. I have been following you all from last six month and this platform helped me to come out of the depression faced due to my diagnosis. I was diagnosed in July end last year. I went through the the test cos of one exposure I had in May end. However I couldn't able to gather my self after that and never visited a doctor for medicines. Than there was a series of sore throat cough. Which made me to consult a doctor. And I started ARV. My baseline measurements were cd4: 555 and viral.load 1,00,000. After six months of my medicines I can say that I was completely adherent. Though I missed the dose timings by +-1 hour (sometimes) but I never forgot my medicines. But after six months my cd4 has not recovered much. Now my cd4 is 580. I found people here who's cd4 just jumped hundreds after starting ARV where as mine it was just 30 increase. Is that mean my chances of recovery is less. Or should I change the drug. I am on atripla right now. Gonna get my viral.load test results today.
One more question if I ever get undetectable can I get physical again (with condom) without transmitting it ahead. I'm frightened. Pls help.

[Mojito]

Hi Hope4life,

The primary goal is to keep the virus suppressed to undetectable  levels through ARV. You have not mentioned what was your viral load after 6 months. If it is getting lower and your CD4 count is above 400, things are good. CD4 as i understand through this forum is a very wide range of 400 - 1600 and depends on lot of other stuffs.But as long as it is above 400, it is good. Also for some people the CD4 count increase is at a less pace than for others. Do not rush to change your drugs if it is working to keep the virus suppressed.

And yes undetectable is equal to untransmittable. You cannot pass on the virus if you are undetectable.

[daveR]

Your CD4 count was normal to begin with so no need to fret over no change. Your body will do whatever it wants to with them, your meds have no direct control. I am betting that after 6 months on Atripla with excellent adherence you will be undetectable. The hours difference every now and then is insignificant.

Just stick at it and live your life.

Good luck
Dave

[leatherman]

But after six months my cd4 has not recovered much. Now my cd4 is 580. I found people here who's cd4 just jumped hundreds after starting ARV where as mine it was just 30 increase. Is that mean my chances of recovery is less.

HIV meds do absolutely nothing for your cd4 count. All the meds do is reduce the HIV viral load. When HIV is suppressed, your immune system can recover (i.e. cd4 "may" increase). There is no med that will increase your cd4 count.

since the "normal" range is anywhere from 400/500 to 1600, your cd4 count has already been in the normal range and you may see little to no cd4 change. Since you, like everyone else, never had a cd4 count prior to HIV infection, you have no idea what your "normal" range was. So worrying about getting to a certain level is simply wasted energy and unnecessary stress.

also, I would point out, that the cd4 count is NOT a measure of "healthiness". It's just a snapshot of the quantity of cd4s at testing time. It is not a measure of how effective those cd4s are. The general wisdom is that MORE cd4s will fight off more illnesses. However, some people with high cd4 counts (>500) can still have many health issues and people with low cd4s (>200 but <500) can be quite healthy.

that's why what you need to watch is simply the viral load count (especially with a cd4 already in the normal range and nowhere near the <200 "aids"-range), which you want to be "undetectable" (i.e. under 200, and preferably under 20) by remaining adherent to daily ARVs. When your VL is suppressed, your immune system (which is based on your genetics) can recover to whatever level it will recover to.

[Bartlett]

Don't stress about the CD4 count it will only give you a headache (look at mine in the signature, very inconsistent.) The thing to remember is that the test is a single "snap-shot" in time and that your number could fluctuate greatly throughout the day. Get your VL results and track that number if you want to track something.

You got this!

[Hope4life]

Thanks Bartlet, leatherman, daveR and mojito for your support and suggestions. There is an update about my viral load testing. I am undetectable now (<40). I am very happy. Now I actually don't feel like a walking disease. My mind and thoughts are settled now. I am doing gud with this condition. Accepted the reality. However some time I feel alone. I feel like I'm living a dual life.
I am medical student, I read everything about these drugs in my pharmacy days however I feel devastated that now I am taking all such drugs. These feelings come and go. But when ever I feel them I feel bad..very bad. I wanted to settle abroad in Europe. But now this may not be possible.
I didn't cry when I was tested positive. Cos I knew now nothing can be done. I knew I have to start medication as soon as possible but there was a pain and fear of stigma. That made me to wait. In begining I got depressed feelings cos of hiv. I used to say ''why me?''. I was always been nice to everyone. I was always been nice guy why? Actually I googled suicide options too. But when I was looking at those, I came to know about the UD=UT concept. And I read a line stating '' do not die out of ignorance''.
That slogan/line was ray of positivity in my life. And I started reading about UD things. From there I came to know about POZ community. And I must say that day I realised how naive I was or am. Thanks guys for helping me out. I know all such things I just wrote now is random and much of it don't make any sense. However I am bit emotional today.
I cried today when I saw UD results. 
Thanks again I hope we all will be here till we find the cure and we will witness the making of another forum:cured members:::: waiting for the day. Till then adherence is my only choice.

[harleymc]

I'm glad to read that you are doing better.

Once you are achieving virological suppression then the actual cd4 counts don't seem to be highly relevant.
I've been plodding along with my VL below 200 for the last 6 years with no periods of illness.

Your anxieties and depression could probably do with some work. There's nothing wrong with seeing a clinical psychologist during a relatively well period, you'll have the energy to do the work required.

There's a mass of tools out there, mindfulness, CBT, exercise, thankfulness, various phone apps, social engagement, and even volunteering. You could even drop a pill a day.  Have a talk with a mental health professional, we don't hav3e to be miserable we can lead good lives.

[Ptrk3]

Congratulations on attaining an undetectable viral load!

Keep to your regimen and all will remain well.

Do seek support for any emotional issues you may have and practice the techniques that harleymc mentions (mindfulness and gratitude are good starts).

Also, there is no reason why you can't settle abroad and if that is what you really wish.  Just take things as they come a day at a time and you will live a long, successful, and healthy life!

[Hope4life]

I'm glad to read that you are doing better.

Once you are achieving virological suppression then the actual cd4 counts don't seem to be highly relevant.
I've been plodding along with my VL below 200 for the last 6 years with no periods of illness.

Your anxieties and depression could probably do with some work. There's nothing wrong with seeing a clinical psychologist during a relatively well period, you'll have the energy to do the work required.

There's a mass of tools out there, mindfulness, CBT, exercise, thankfulness, various phone apps, social engagement, and even volunteering. You could even drop a pill a day.  Have a talk with a mental health professional, we don't hav3e to be miserable we can lead good lives.

Thanks a lot for your concern. Six months before I had concerns regarding all such thing but now I feel very positive in file. I know hiv can not define me. My life has a meaning and that is much bigger than being a seropositive strain in my blood. Yes that's the reality that I have to live with this virus. But this virus is leaving in my body and he has to live by my rules. But yeah life is like a roller costr. Sometime I feel very positive and sometime negative. But one thing for sure that I know that's life and I'm used to it now. Let's see what surprises life has for me in its basket.

I'm glad to read that you are doing better.

Once you are achieving virological suppression then the actual cd4 counts don't seem to be highly relevant.
I've been plodding along with my VL below 200 for the last 6 years with no periods of illness.

Your anxieties and depression could probably do with some work. There's nothing wrong with seeing a clinical psychologist during a relatively well period, you'll have the energy to do the work required.

There's a mass of tools out there, mindfulness, CBT, exercise, thankfulness, various phone apps, social engagement, and even volunteering. You could even drop a pill a day.  Have a talk with a mental health professional, we don't hav3e to be miserable we can lead good lives.

Thanks sir. I am glad for your concern. I hope I will remain here for sharing my thoughts with you all for a much longer time. Thansk again

[Hope4life]

Also, there is no reason why you can't settle abroad and if that is what you really wish.  Just take things as they come a day at a time and you will live a long, successful, and healthy life!

Actually I have an offer to work in Spain. I have checked that there are no hiv restrictions to get visa. However I am not sure about hiv testing. Second what will be the situation of insurance down there. I sent mails to NGO working in Spain. However I didn't get response. If you/ or anyother can give some info on same than I will be grateful to you.

[Jim Allen]

@OP

FYI

I split your prevention question into its own thread.
https://forums.poz.com/index.php?topic=70723

Jim

[MadDog125]

If you read the numbers your actually In the normal range  for a healthy adult.  I experianced a jump from 112 to 298 in about 6.5 months.  Like some of the others were saying though the goal is suppression so the immune system can recover.  Just reading my blood work normal range for an adult cd4 count is 490-1650 that's what the lab lists anyway. 

[Hope4life]

Hi everyone,
I need to ask the similar questions again for more clarification. Actually I met my doctor and she said that she is bit worried about the small increase in cd4 (~550 to ~580) in six month of art, which she considered  nominal or negligible increase. Though she is happy that it didn't go down. moreover she is happy for me being undetectable. However the lower increase in cd4 might be a reason of some underlying disease. Or someother cause.
 However what I studied and got from the suggestions here is that cd4 increase may take time to increase. And moreover we do not know what was our normal.cd4 count before infection so we can't take cd4 as best finding. But my doctor emphasised on one more cd4 count next month.
I want your views over the same.
Another thing where I want suggestions is the viral load in different compartments other than blood. My doctor said we check the viral load in blood but the viral.load changes or sometime shoots in one compartment say semen or tissues. Which may result into transmission. Is it possible ?
And what about the effect of STD(like gonnorrhea) on the viral load in semen when the person is showing undetectable viral load in blood?
  Sorry if I am asking same question again. But need to clarify.

[Jim Allen]

where I want suggestions is the viral load in different compartments other than blood. My doctor said we check the viral load in blood but the viral.load changes or sometime shoots in one compartment say semen or tissues. Which may result into transmission. Is it possible ?

Already answered in your prevention thread, if we can keep prevention questions there it would be appreciated

https://forums.poz.com/index.php?topic=70723

Blood levels VL closely correlate with genital fluids VL and other tissue although depending on the meds it might take longer to reach UD level in genital fluids hence U=U statement and the Swiss statement are that you should be UD for 6 months

The HIV-positive individual takes antiretroviral therapy consistently and as prescribed and is regularly followed by his/her doctor.

Viral load is 'undetectable' and has been so for at least six months.

Your doctor sounds outdated if they are claiming otherwise or not giving context to their statements if I'm honest

Jim

[Jim Allen]

Actually I met my doctor and she said that she is bit worried about the small increase in cd4 (~550 to ~580) in six month of art, which she considered  nominal or negligible increase. Though she is happy that it didn't go down. moreover she is happy for me being undetectable. However the lower increase in cd4 might be a reason of some underlying disease. Or someother cause.
 However what I studied and got from the suggestions here is that cd4 increase may take time to increase. And moreover we do not know what was our normal.cd4 count before infection so we can't take cd4 as best finding. But my doctor emphasised on one more cd4 count next month.

I think you have answered the question yourself. HIV treatment itself does not increase CD4, it supresses the virus.You have only been in treatment a few months and reached UD levels, that's perfect.

An average HIV negative person will range of CD4's that will vary from +- 400 to 1200's , its not a measurement of overall health and it will also vary on age,sex, time of day the measurement is taken

If you test in the AM and same day take the test in the PM you could have a 100 count difference. I last year lost 300 between tests and my ID doctor did not even blink as its irrelevant as long as I'm healthy and UD.

Jim

[Hope4life]

Your doctor sounds outdated if they are claiming otherwise or not giving context to their statements if I'm honest

I though the same thing. thanks and I am really sorry to put my prevention query here as I though as a new user I am restricted to one thread only. But I will keep that in mind.

If you test in the AM and same day take the test in the PM you could have a 100 count difference. I last year lost 300 between tests and my ID doctor did not even blink as its irrelevant as long as I'm healthy and UD.

Thanks for the inputs that answered everything.

Regards