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Author Topic: CD4 > 646, VL > 180,000  (Read 6964 times)

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Offline ScottPhxAZ

  • Member
  • Posts: 26
CD4 > 646, VL > 180,000
« on: July 06, 2007, 12:52:41 pm »
I have never been on meds. In the 12 months since I was infected, my CD4 has never slipped below 646 and my VL has never gone below 184,000. My CD4% has remained a steady 22-23%.

According to current treatment guidelines, when CD4 > 350 and VL > 100,000 " most experienced clinicians defer therapy but some clinicians may consider initiating treatment." (source: http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf)

At the moment I am content to continue monitoring my CD4 numbers and delay any meds until those numbers fall. I don't place as much weight on VL as I do CD4, but I am concerned because by now I was expecting my VL to drop below 100,000.

Unfortunately, I can find very little information to explain why some clinicians may consider starting treatment. I have an appointment with my doctor next week and he wants to start talking about meds so I am hoping to find some info or opinions about the treatment threshold of CD4 > 350 and VL > 100,000. So like I said I am content for the moment but would appreciate either agreement or disagreement or points to ponder about my current numbers.

Thanks in advance for your response,
Scott

07/06 infected; K103N mutation (excludes non-nukes)
Date  CD4/%      VL
08/06 867/23%  1,000,000+
09/06 646/20%     434,000
10/06 948/24%   1,710,000
02/07 851/23%      439,000
04/07 CD4: 701/23%  VL:    184,000
06/07 CD4: 697/         VL:    202,000
08/07 CD4: 565/19%  VL:    184,000
08/07 Started Truvada+Viracept
11/07 CD4: 769/27%  VL:          181
02/08 CD4: 998/23%  VL:         <48
05/08 CD4: 809/26%  VL:         <48
06/08 Stopped meds while traveling
09/08 CD4: 793/31%  VL:         <48
12/08 CD4: 739/21%  VL:     27,700
02/09 CD4: 60
05/09 CD4: 508/22%  VL:     19,400
08/09 CD4: 358/22%  VL:     62,600
10/09 CD4: 548/26%  VL:         <48
01/10 CD4: 468/28%  VL:         <48
05/10 CD4: 475/34%  VL:         <48

Offline aztecan

  • Member
  • Posts: 5,530
  • 36 years positive, 64 years a pain in the butt
Re: CD4 > 646, VL > 180,000
« Reply #1 on: July 06, 2007, 01:18:07 pm »
Hey Scott,

Those treatment guidelines are just that, guidelines. I have known people who have had in excess of 100,000 viral load and a healthy CD4 (usually greater than 500), who have simply maintained the status quo for quite a while. In other words, their viral load doesn't decrease, but neither does their CD4.

What are the long-term implications of this? I don't know.

How are your trends doing? Are you holding steady, albeit with a high viral load, or do repeated tests show a decline in progress? That is the first thing I would look at, were I you.

The second issue is whether you are ready to start meds. Some people have little choice when they find out, you have the luxury of time.

If you aren't ready, or really don't want to start meds at this time, your chances of not being adherent to the regimen are increased and, through this resistance and other problems.

Starting meds is a commitment. I don't regret starting meds myself when my CD4s were in the 400s. But others really have a hard time dealing with it.

How do you feel about it? Like I said, right now, you have the luxury of time on your side. With a CD4 in the 600s and a percentage above 21, you still have wiggle room.

The person to talk to about this is your doc. Let him know any concerns you have and problems you foresee with starting treatment. Also make sure you ask all the questions that come to you: adherence, side effects, etc.

I am an advocate of starting sooner rather than later, but not if the person is just being set up to fail.

HUGS,

Mark
« Last Edit: July 06, 2007, 01:20:52 pm by aztecan »
"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline redhotmuslbear

  • Member
  • Posts: 605
  • A genuine certified freak of nature, and a hot one
Re: CD4 > 646, VL > 180,000
« Reply #2 on: July 06, 2007, 01:48:36 pm »
I have never been on meds. In the 12 months since I was infected, my CD4 has never slipped below 646 and my VL has never gone below 184,000. My CD4% has remained a steady 22-23%.....
At the moment I am content to continue monitoring my CD4 numbers and delay any meds until those numbers fall. I don't place as much weight on VL as I do CD4, but I am concerned because by now I was expecting my VL to drop below 100,000.

Unfortunately, I can find very little information to explain why some clinicians may consider starting treatment.


Scott,
Are you certain that your CD4s have been steadily in the low 20s percent-wise?  If so, that's low and a good reason for initiating meds.

What I'm sensing from the trends in your numbers without percentages is that you are continuing to lose CD4s while you body has been neogitating HIV infection to some degree.  Many docs don't want patients to slip into the threat zone below CD4=350, and so they promote the "hit early" approach.  In any case, as Mark pointed out, you need to be prepared intellectually and emotionally for taking meds for you to take them properly and to benefit from them--a few pills will make HIV real in your life like never before.

Since there would appear to be "wiggle room" in the timelines before considering meds, I'd also encourage you to look at joining a clinical trial in your area of HIV therapies -- you might get free meds or a placebo to start your pill-popping career!   ;D  Glaxo Smith Kline has a trials facility in Phoenix 1-877-379-3718, and you can cruise nationwide listings through NIH's site at http://www.clinicaltrials.gov

Peace,
David
"The real problem is not whether machines think but whether men do." - BF Skinner
12-31-09   222wks VL  2430 CD4 690 (37%)
09-30-09   208wks VL  2050  CD4 925 (42%)
06-25-08   143wks VL  1359  CD4 668 (32%)  CD8 885
02-11-08   123wks off meds:  VL 1364 CD4 892(40%/0.99 ratio)
10-19-07   112wks off meds:   VL 292  CD4 857(37%/0.85 ratio)

One copy of delta-32 for f*****d up CCR5 receptors, and an HLA B44+ allele for "CD8-mediated immunity"... beteer than winning Powerball, almost!

Offline ScottPhxAZ

  • Member
  • Posts: 26
Re: CD4 > 646, VL > 180,000
« Reply #3 on: July 06, 2007, 02:21:45 pm »
Hi David/Mark,

Ya that's a big 10-4 on being prepared for the meds. I have researched them, I know my resistances, and already have a pretty fair idea of what I would start, how many/how often, and what the side effects are. When the time comes I will be ready. I was just hoping my VL would dip below 100,000 and that time would appear to be further out.

That CD4% is not as clearly defined as I would like it to be. Most common that I have read uses 17% and 20% loosely similar to CD4 counts of 200 and 350. (Meaning that 20% is a concern, 17% is bad.) I would be grateful if you could point me someplace that discusses the highs and lows of CD4%. For the moment, I am less concerned that it is 22-23% than I would be if it starts to drift lower to 20% or below. Like all of my numbers, I am more concerned about how they trend over time rather than what they are at any given moment. Both my CD4 and VL have been bouncing - nothing unusual for one's first year of being positive. (I've had more tests than I show below but I need to get copies from the doctor. They are similar.)

If I go into the 500's or below 20% with CD4 and my VL stays high then that will probably be enough for me to start.

If my VL stabilizes below 100,000 then I will probably stick pretty close to the guidelines though keeping an extra eye on CD4%.
07/06 infected; K103N mutation (excludes non-nukes)
Date  CD4/%      VL
08/06 867/23%  1,000,000+
09/06 646/20%     434,000
10/06 948/24%   1,710,000
02/07 851/23%      439,000
04/07 CD4: 701/23%  VL:    184,000
06/07 CD4: 697/         VL:    202,000
08/07 CD4: 565/19%  VL:    184,000
08/07 Started Truvada+Viracept
11/07 CD4: 769/27%  VL:          181
02/08 CD4: 998/23%  VL:         <48
05/08 CD4: 809/26%  VL:         <48
06/08 Stopped meds while traveling
09/08 CD4: 793/31%  VL:         <48
12/08 CD4: 739/21%  VL:     27,700
02/09 CD4: 60
05/09 CD4: 508/22%  VL:     19,400
08/09 CD4: 358/22%  VL:     62,600
10/09 CD4: 548/26%  VL:         <48
01/10 CD4: 468/28%  VL:         <48
05/10 CD4: 475/34%  VL:         <48

Offline J.R.E.

  • Member
  • Posts: 8,207
  • Positive since 1985, joined forums 12/03
Re: CD4 > 646, VL > 180,000
« Reply #4 on: July 06, 2007, 09:01:25 pm »


Unfortunately, I can find very little information to explain why some clinicians may consider starting treatment. I have an appointment with my doctor next week and he wants to start talking about meds so I am hoping to find some info or opinions about the treatment threshold of CD4 > 350 and VL > 100,000. So like I said I am content for the moment but would appreciate either agreement or disagreement or points to ponder about my current numbers.

Thanks in advance for your response,
Scott




Hello Scott,

And it's kind of frustrating isn't it ? Welcome to the forums. I certainly don't have the answers for you, when I started on treatment my percentage was at 4 percent. Tcells were at 16 viral load at 500,000. I would also suggest that no one allow themselves to get to this point !

My own thought are, as long as your percentages remain above 20% that's a good thing. Keep those opportunistic infections away from you !! I would also be watching that viral load carefully !

From the lessons section : ( just a little info here)

The T4 percentage is sometimes a more reliable measurement than the T4 count because it tends to vary less between measurements. For example, one person's T4 count may vary between 200 and 300 over a several month period while their T4 percentage remains constant at, say, 21%. Provided that the T4 percentage stays at 21% or higher, the immune system still appears to be functioning properly, regardless of what the T4 count is. At the same time, a T4 percentage at or below 13% – regardless of what the actual T4 count is – usually means that the immune system is damaged and that it is time to begin prophylactic treatment (drugs to prevent diseases) for opportunistic infections like PCP.

Have you also checked out the lessons on this site ? :


http://www.aidsmeds.com/articles/WhenToStart_4758.shtml You will see pro and con arguments here for when to start treatment.


http://www.aidsmeds.com/articles/WhenToStart_4759.shtml  ( what should I take)



http://www.aidsmeds.com/articles/WhenToStart_4757.shtml




Take care of yourself----Ray


« Last Edit: July 06, 2007, 09:06:30 pm by J.R.E. »
Current Meds ; Viramune / Epzicom Eliquis, Diltiazem. Pravastatin 80mg, Ezetimibe. UPDATED 2/18/24
 Tested positive in 1985,.. In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started on  HAART on October 24th, 2003.

 As of Oct 2nd, 2023, Viral load Undetectable.
CD 4 @676 /  CD4 % @ 18 %
Lymphocytes,absolute-3815 (within range)


72 YEARS YOUNG

Offline aztecan

  • Member
  • Posts: 5,530
  • 36 years positive, 64 years a pain in the butt
Re: CD4 > 646, VL > 180,000
« Reply #5 on: July 07, 2007, 01:47:39 pm »
Hey Scott,

You seem to have a good handle on the meds issue and I applaud the fact you watch for trends. Sometimes people panic over one set of labs.

Sorry, I now see you have your labs posted so I see there has been an overall decline over a period of time in the CD4 numbers. Back in the old days, we started talking meds when someone dipped below 500 CD4s. Your statement that, with a viral load as high as yours, you are considering starting once you dip down into those numbers is both prudent and wise, in my humble opinion.

You seem emotionally/intellectually ready to start meds when the time comes, which I believe is another plus in your favor.

Let us know how things go.

HUGS,

Mark
"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline ScottPhxAZ

  • Member
  • Posts: 26
Re: CD4 > 646, VL > 180,000
« Reply #6 on: July 08, 2007, 12:49:47 am »
FYI: I posted the following question for the docs on thebody.com and they answered:

Jul 7, 2007 Another CD4% Question: Can you say what CD4% might be normal based on actual CD4? For example, my CD4% has been a solid 23% while my CD4 count has been 650-950, but my VL has never gone below 184,000 since my infection 1 year ago. I'm wondering if my VL stays over 100,000 when my CD4% might suggest treatment when my actuals are still above 200/350 thresholds.
 
Response from Dr. Holodniy: For a CD4 count above 600, you should probably have a CD4% of 30% or more. So you have taken a bit of a hit already. Current guidelines do state that in those people with a CD4 count > 350, if they have a viral load consistently > 100,000, then treatment should be seriously considered. So you are potentially there already.


So basically I am at that point where any further drop in CD4 or CD4% without a significant drop in VL would seem to have me on meds.

I am going to do another set of labs at the end of the month and make a decision then.
07/06 infected; K103N mutation (excludes non-nukes)
Date  CD4/%      VL
08/06 867/23%  1,000,000+
09/06 646/20%     434,000
10/06 948/24%   1,710,000
02/07 851/23%      439,000
04/07 CD4: 701/23%  VL:    184,000
06/07 CD4: 697/         VL:    202,000
08/07 CD4: 565/19%  VL:    184,000
08/07 Started Truvada+Viracept
11/07 CD4: 769/27%  VL:          181
02/08 CD4: 998/23%  VL:         <48
05/08 CD4: 809/26%  VL:         <48
06/08 Stopped meds while traveling
09/08 CD4: 793/31%  VL:         <48
12/08 CD4: 739/21%  VL:     27,700
02/09 CD4: 60
05/09 CD4: 508/22%  VL:     19,400
08/09 CD4: 358/22%  VL:     62,600
10/09 CD4: 548/26%  VL:         <48
01/10 CD4: 468/28%  VL:         <48
05/10 CD4: 475/34%  VL:         <48

Offline J.R.E.

  • Member
  • Posts: 8,207
  • Positive since 1985, joined forums 12/03
Re: CD4 > 646, VL > 180,000
« Reply #7 on: July 08, 2007, 07:33:11 am »

Current guidelines do state that in those people with a CD4 count > 350, if they have a viral load consistently > 100,000, then treatment should be seriously considered. So you are potentially there already.



I agree with that statement. One of the links I provided from the lessons on this site, states that. I was concerned about the consistently high viral load, that never dropped below 180,000.

http://www.aidsmeds.com/articles/WhenToStart_4757.shtml


Take care------Ray
Current Meds ; Viramune / Epzicom Eliquis, Diltiazem. Pravastatin 80mg, Ezetimibe. UPDATED 2/18/24
 Tested positive in 1985,.. In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started on  HAART on October 24th, 2003.

 As of Oct 2nd, 2023, Viral load Undetectable.
CD 4 @676 /  CD4 % @ 18 %
Lymphocytes,absolute-3815 (within range)


72 YEARS YOUNG

Offline ScottPhxAZ

  • Member
  • Posts: 26
Re: CD4 > 646, VL > 180,000
« Reply #8 on: July 08, 2007, 12:08:22 pm »
Which brings me back around full circle to my original question: when CD4 is > 350 and VL > 100,000, what other factors should be considered for starting therapy? The guidelines say MOST DO NOT RECOMMEND but that some do. I am somewhat distressed that I cannot find much discussion about that part of the treatment guidelines. Everything seems centered on CD4 actuals. By that standard I am A-OK but apparently not.

Thus far I have found three factors to consider:

1. CD4%
2. General Health
3. Readiness for therapy

2 and 3 are nothing new and are in fact considerations whenever starting meds. So that leaves me looking at CD4%. I did discover that a low enough CD4% can have you automatically diagnosed with AIDS regardless of CD4 actuals. I find it interesting that I cannot find a single discussion, article, or reasearch abstract that talks about comparative levels of CD4%. Everything I know is pieced together from multiple sources. I have found tons of info on CD4% just not many numbers that you can say high/low to based on factors such as CD4 actuals or VL levels. It would seem that information is flat out missing from the treatment guidelines.
07/06 infected; K103N mutation (excludes non-nukes)
Date  CD4/%      VL
08/06 867/23%  1,000,000+
09/06 646/20%     434,000
10/06 948/24%   1,710,000
02/07 851/23%      439,000
04/07 CD4: 701/23%  VL:    184,000
06/07 CD4: 697/         VL:    202,000
08/07 CD4: 565/19%  VL:    184,000
08/07 Started Truvada+Viracept
11/07 CD4: 769/27%  VL:          181
02/08 CD4: 998/23%  VL:         <48
05/08 CD4: 809/26%  VL:         <48
06/08 Stopped meds while traveling
09/08 CD4: 793/31%  VL:         <48
12/08 CD4: 739/21%  VL:     27,700
02/09 CD4: 60
05/09 CD4: 508/22%  VL:     19,400
08/09 CD4: 358/22%  VL:     62,600
10/09 CD4: 548/26%  VL:         <48
01/10 CD4: 468/28%  VL:         <48
05/10 CD4: 475/34%  VL:         <48

Offline newt

  • Member
  • Posts: 3,900
  • the one and original newt
Re: CD4 > 646, VL > 180,000
« Reply #9 on: July 08, 2007, 06:59:15 pm »
You are basically in Guessing Alley.

These articles may help. Alternatively they may add nothing:

CD4 percentage could help decide when to start treatment

Start HIV treatment when CD4 cell count is 350, say leading HIV doctors in BMJ

It is impossible to relate CD4 count and CD4% in an individual without baseline scores for both adjusted for age.  You do not meet the guideline recommendation on CD4 count + viral load but looking at CD4% you do perhaps. 

Risk of opportunistic infections is very reliably predicted by CD4 count, and a CD4 count of over 500 indicates very little risk, 350+ indicates a working immune system more or less...regardless of CD4%.  UK guidelines, a little more conservative than US ones but rigorous with the evidence, don't even mention viral load in the context of deciding to start combo because it seems to be neither here nor there (the authors judge) it terms of (1) treatment success (2) health and immunological outcomes .... they recommend treatment at any CD count if symptomatic (because the benefits outweight the risk) but not with CD count of 350+ if asymptomatic (because the risks outweigh the benefits) and "consider" between 349 and 200.

So, I believe your question will not get a definitive answer. One expert will say start, one will say wait, some will (as per guidelines) consider viral load over 100k important, others think it beside the point.  It is a fair call in my book to set for yourself a CD4 count or the equivalent CD4% and start when 2-3 tests suggest this is a real point in a trend rather than a one-off.

An HIV infection with a CD4 count consistently over 350 and a more or less level viral load and CD4% is basically stable, your immune system is not diving, the virus is managed for the time being, this gives time to consider the merits of starting treatment in depth, or indeed ignore the question for a while.

2 and 3 are important considerations.

Maybe this helps

- matt
« Last Edit: July 08, 2007, 07:07:04 pm by newt »
"The object is to be a well patient, not a good patient"

Offline ScottPhxAZ

  • Member
  • Posts: 26
Re: CD4 > 646, VL > 180,000
« Reply #10 on: July 08, 2007, 09:37:59 pm »
Thanks Newt!

I have seen that 17% figure cited before but the one piece of info in the article that is new to me is that we are supposed to be pushing 40% if our CD4 is 400-1600. My 23% isn't anywhere near 40% and a little too close to 17% for my comfort.
07/06 infected; K103N mutation (excludes non-nukes)
Date  CD4/%      VL
08/06 867/23%  1,000,000+
09/06 646/20%     434,000
10/06 948/24%   1,710,000
02/07 851/23%      439,000
04/07 CD4: 701/23%  VL:    184,000
06/07 CD4: 697/         VL:    202,000
08/07 CD4: 565/19%  VL:    184,000
08/07 Started Truvada+Viracept
11/07 CD4: 769/27%  VL:          181
02/08 CD4: 998/23%  VL:         <48
05/08 CD4: 809/26%  VL:         <48
06/08 Stopped meds while traveling
09/08 CD4: 793/31%  VL:         <48
12/08 CD4: 739/21%  VL:     27,700
02/09 CD4: 60
05/09 CD4: 508/22%  VL:     19,400
08/09 CD4: 358/22%  VL:     62,600
10/09 CD4: 548/26%  VL:         <48
01/10 CD4: 468/28%  VL:         <48
05/10 CD4: 475/34%  VL:         <48

Offline ScottPhxAZ

  • Member
  • Posts: 26
Re: CD4 > 646, VL > 180,000
« Reply #11 on: July 12, 2007, 10:55:45 am »
Soooooo....... In consultation with my doctor I've decided to start meds, pending my next set of test results. I'll have blood drawn in early August and if the numbers aren't changing in my favor I'll go with either Viracept + Truvada or Kaletra + Truvada depending on where my CD4's are. School starts mid-August and I have a trip out of town as well so I am aiming to start once that's all out of the way.

So now I have something to obsess over for the next 7 weeks!
07/06 infected; K103N mutation (excludes non-nukes)
Date  CD4/%      VL
08/06 867/23%  1,000,000+
09/06 646/20%     434,000
10/06 948/24%   1,710,000
02/07 851/23%      439,000
04/07 CD4: 701/23%  VL:    184,000
06/07 CD4: 697/         VL:    202,000
08/07 CD4: 565/19%  VL:    184,000
08/07 Started Truvada+Viracept
11/07 CD4: 769/27%  VL:          181
02/08 CD4: 998/23%  VL:         <48
05/08 CD4: 809/26%  VL:         <48
06/08 Stopped meds while traveling
09/08 CD4: 793/31%  VL:         <48
12/08 CD4: 739/21%  VL:     27,700
02/09 CD4: 60
05/09 CD4: 508/22%  VL:     19,400
08/09 CD4: 358/22%  VL:     62,600
10/09 CD4: 548/26%  VL:         <48
01/10 CD4: 468/28%  VL:         <48
05/10 CD4: 475/34%  VL:         <48

Offline redhotmuslbear

  • Member
  • Posts: 605
  • A genuine certified freak of nature, and a hot one
Re: CD4 > 646, VL > 180,000
« Reply #12 on: July 12, 2007, 12:04:47 pm »
if the numbers aren't changing in my favor I'll go with either Viracept + Truvada or Kaletra + Truvada depending on where my CD4's are.


Why not a mix less prone to adverse side effects like Viramune + Truvada and "saving the PIs," as it were?  I know several HAART newbies who have started out with Viramune+Truvada with great results--a little liver 'irritation, but not nearly as disconcerting as the new relationship with the toilet developed by others who went for Viracept and Kaletra.
"The real problem is not whether machines think but whether men do." - BF Skinner
12-31-09   222wks VL  2430 CD4 690 (37%)
09-30-09   208wks VL  2050  CD4 925 (42%)
06-25-08   143wks VL  1359  CD4 668 (32%)  CD8 885
02-11-08   123wks off meds:  VL 1364 CD4 892(40%/0.99 ratio)
10-19-07   112wks off meds:   VL 292  CD4 857(37%/0.85 ratio)

One copy of delta-32 for f*****d up CCR5 receptors, and an HLA B44+ allele for "CD8-mediated immunity"... beteer than winning Powerball, almost!

Offline ScottPhxAZ

  • Member
  • Posts: 26
Re: CD4 > 646, VL > 180,000
« Reply #13 on: July 12, 2007, 12:27:49 pm »
Why not a mix less prone to adverse side effects like Viramune

Sorry, I failed to mention I have the K103N mutation that excludes the the non-nukes.

The doc wants to skip Norvir due to my 'normal' CD4's. He thinks Viracept without Norvir carries less risk of developing a class resistance than unboosted Lexiva, Reyataz, etc..

Oh, and my doctor said the side effects wouldn't be a problem. LOL! I said "Easy for you to say! When's the last time you took either of those?"
« Last Edit: July 12, 2007, 12:35:41 pm by ScottPhxAZ »
07/06 infected; K103N mutation (excludes non-nukes)
Date  CD4/%      VL
08/06 867/23%  1,000,000+
09/06 646/20%     434,000
10/06 948/24%   1,710,000
02/07 851/23%      439,000
04/07 CD4: 701/23%  VL:    184,000
06/07 CD4: 697/         VL:    202,000
08/07 CD4: 565/19%  VL:    184,000
08/07 Started Truvada+Viracept
11/07 CD4: 769/27%  VL:          181
02/08 CD4: 998/23%  VL:         <48
05/08 CD4: 809/26%  VL:         <48
06/08 Stopped meds while traveling
09/08 CD4: 793/31%  VL:         <48
12/08 CD4: 739/21%  VL:     27,700
02/09 CD4: 60
05/09 CD4: 508/22%  VL:     19,400
08/09 CD4: 358/22%  VL:     62,600
10/09 CD4: 548/26%  VL:         <48
01/10 CD4: 468/28%  VL:         <48
05/10 CD4: 475/34%  VL:         <48

 


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