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My friend with a very low CD4 in Thailand

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Expat1:
His Story:

-4years........Hospitalized with TB for several weeks.
-3years....... Cleared TB.  Joined military.
-1 year ....... Serious motorcycle accident.  In hospital with fractured skull and lost 8
           teeth.
May1 This year another different friend becomes HIV+ discovered during wife's
          pregnancy.
I Encourage all my friends to get tested for HIV and STDs.
Several Do
One case Syphilis.
Sept 5.  Day 0

This friend is diagnosed HIV+  AND Syphilis postive.  Teiter 1:2.
Goes to local hospital.  Additional test for Syphilis taken. 
Decision made to start Syphilis treatment before HIV ARV treatment.  No Viral Load. No CD4 test.

Day 3 to 18. 
Told to return on October 15.  No ARVs given. No further tests.
Successful treatment. 
3 shots over 2 weeks.

Oct 15 Day 40 given tests for CD4 no Viral Load.  Also given Blood panel.  No Genotype.
Upset that they are running this slowly.  He starts taking a friends ARV meds. TDF/FTC/RPV. 

Day 65
Nov. 9 gets.  Results of CD4 count.  It is 3.  Percentage less than 1 percent.
Referred to another hospital.  He goes to local pharmacy and gets Septrin Tablets to add to the Unsupervised ARVs.

His Universal Health Card from working has expired.   He needs to process documents to get access to hospital.

Gets a packet  of sealed documents.  Told when he gets the results, go to referral hospital. 

Day 68.  I take him to a private Doctor at an NGO.  The private doctor is not happy he has started taking ARVs without supervision.  Doctor continues the TDF/FTC/RPV.

I am a bit pissed off....   If the government hospitals had done their job, he would have already been on his 3rd month of ARVs.  They havent even begun.

Day73
Private Doctor, takes additional tests.  He is Crypto positive.
The Doc feels orders Viral Load tests.  (They come back at 20,000.) A new CD4 it comes back at 34.   And while waiting for genotype tests, puts him on d4t/3TC/ plus Kaletra. 



Concerned the RPV may have caused mutants.  Stops the tenofovir because his Creatinine went from .7 to 1.43 in a month.  eGFR from 132 to 67.
Told to return in 1 week started on 400 mg of fluconazole for Crypto prevention.

Tomorrow he is going to try to work out the government insurance.  He spent an additional $400 for the lab tests. And meds.

He is currently unemployed.  (He was working at a gas station and put diesel into a gas car.)  He was fired.  Not paid his last months wages as it was used to pay the driver of the car for damages.  (No worker protections here.)

Anyway he lives on my sofa (actually spare bedroom). And it trying to get through this...... so am I.

He sees the Private doctor on Thursday.   To determine meds. And next steps.   He has meds till Thursday.   

Except for the very low CD4 he is thus far asymptomatic.   No IRIS yet.  Lung Xray and abdominal ultrasound clear.




ZachR:
Hey Expat... feeling deeply sorry, actually crying while reading the story.. Why people have to suffer so much..anyway, sadness won't save the world.
Can't give any advice, I got 4month's supply of Triumeq that I would gladly send, but I believe it is illegal and he is on a different regimen. However, you can ask his doctor and if he approves, then I could send them by finding a legal way to do so, yet that wouldn't be a sustainable approach. Hope things get better asap for you and your friends.
Also you can consider some local and international charities and organisations that support HIV+ people.

My sincerest compassion.
Zach

Expat1:
Thanks for the support Zach.

I already cried me a river.

We can get him HIV meds.  Money for meds is not an issue at present. 

The issue I have is that he was missed by TB hospital, Army, Local Hospital.  Which all had him in the past 4 years.   

Also when finally Dx, got inadequate treatment.  (They still dont know he has started ARV treatment.)  As their last contact was "Get you government health insurance then take this packet of documents to your local sub district hospital.

He goes back to local non government doctor on Thur.  HIs genotype should be ready.  That doctor wants to hand him off to government hospitals. (Probably because of the danger of OIs.) 

Tomorrow he will see about getting government insurance.   If  he has trouble with this, an HIV advocate  has volunteered to walk him through it if he can. 

He runs out of meds on Thur.  Hopefully will get meds from the local ngo doctor. 

If that fails, I take him to Bangkok and Thai Red Cross on Friday or Saturday.

Still, OIs are a big problem that he could face.  Not really sure what would happen if we need to take him to the ER with a fever etc.   

Expat1:
Update:

He Got government health card so can use sub-district government hosptial for free treatment.  ER, clinics, etc.

Local NGO doctor has decided to remain directing treatment for at least one more month since he has all the tests results, and can change treatment quickly and more efficiently than government hospital especially with with prophylaxis of OIs.   Also he can go get inpatient treatment free if necessary now. Once he gets on a stable regiment and his viral load becomes undetectable, he will transition him to the Government HIV treatment program so that he can get free medicine and care.  I can afford his arvs and oi prevention meds.

He still has no overt symptoms of AIDS. 

He was offered a job, but he is high risk from multiple public contacts  and he might need to be hospitalized in the next few months as his immune system starts activating again.. So doctor talked him out of work at present.  I agree.  So he decided not to work at present.

He can stay in spare room as long as he needs too.  If he becomes sick, I can transport him to the ER at the local hospital where he can now get care.

So I think we got all the supports in place. 

Thanks for the encouragement Zach, Leatherman, Ward.

ZachR:
I think your friend is the luckiest man on earth to have a friend like you. What you are doing to help your friend has greatly inspired me. :)

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