Mixed feelings about 1 year labs

[texaninnyc87]

I just got my labs after my one year mark.
No stds/stis, everything in optimum zone. They did randomly drug test me and I tested positive for cannaboids and cocaine (whoops, fun weekend) but anyways.

Cd4: 846! 36%! Huge increase, obviously very happy about this.
Vl: 100

So it seems I've had a vl blip or something. I know it's probably nothing but I can't help but worry. Obviously for my cd4 to have risen so much it doesn't seem like I really should be worried and I know blips happen but...I was just wondering if its something I'm doing? I try to always take my meds in a 3 hour window (with breakfast daily, but sometimes I sleep late) and always with food (stribild). Should I try to be more vigilant about timing or am I just freaking out for no reason?

I feel like it took me so long just to get to that official UD point and now after only one time coming back UD I'm already back to detectable. 

Again, super happy about the cd4, just annoyed to not be UD and that I have to go back for more blood work in a month.

Thoughts?

[Ann]

Should I try to be more vigilant about timing or am I just freaking out for no reason?

You're freaking out for no good reason.

Why do they randomly drug test you? I'd be pretty pissed off if my clinic did that to me. If they can't take my word for it about my drug intake (or alcohol for that matter), they can take a running leap.

[texaninnyc87]

I thought the drug test was strange too. They've never done it before and I've always been very open with them about my drug and alcohol use. I'm glad someone else thought it was bizarre.

[Jmarksto]

Hey Texan; 

I had a blip with my last labs too -- my doctor noted the blip and said don't worry about it and come back in four months as usual.  I did have a flu shot less than a week before my last test, I wonder if something like that could have caused the blip.  Also, as others here have noted - the sensitivity of the tests have increased significantly and it wasn't long ago that our blips would still have been UD.

My doc put me at ease about it, I don't think you should freak out.

Enjoy your weekends!

JM

[aaware72]

You're freaking out for no good reason.

Why do they randomly drug test you? I'd be pretty pissed off if my clinic did that to me. If they can't take my word for it about my drug intake (or alcohol for that matter), they can take a running leap.

I agree random drug test?  Ordered by who? and for what? 

[texaninnyc87]

No clue about the drug test. My doctor said any blip is something to be taken seriously and wants me to come in for monthly blood work until I'm back to undetectable. Ugh.

[tednlou2]

I've seen this drug testing thing before here.  Do you get ADAP?  Do some states require a drug test?  I wouldn't be surprised, since states like Florida does it for food stamps. 

Personally, I think this a really bad idea.  It could cause many to not want to get treatment or delay doc visits.  Anyway, congrats on the great labs! 

[Ann]

I've seen this drug testing thing before here.  Do you get ADAP?  Do some states require a drug test?  I wouldn't be surprised, since states like Florida does it for food stamps. 

Personally, I think this a really bad idea.  It could cause many to not want to get treatment or delay doc visits.  Anyway, congrats on the great labs! 

I wondered if it were tied to a public funded clinic/situation as well. I sure hope that's not the case!


I was over in Liverpool earlier this week for clinic and I had a blip too - a whopping 25. The doc read it out and looked at me - I shrugged and said, "eh, a blip". He asked if I were concerned and I said "no, I take my meds every day, in the afternoon, with food. It's just a blip."

He was relieved that I wasn't freaked out and said that they (the clinic) were in the process of switching back to a less sensitive assay - for the simple reason that these types of blips were clinically insignificant and caused more worry than they were worth. He said that not only did a lot of patients freak out, but some of the lesser-experienced docs did too.

Just a few years ago anything under 500 (and a few years before that, under 1000) was UD and nobody freaked over these low-level blips because we were unaware they were happening.  Sometimes advanced technology is just a pain in the arse, and sometimes ignorance truly is bliss.

[texaninnyc87]

I do get ADAP but I would hope if the drug testing thing were some kind of new policy someone would've informed me. Also, I feel like people who are not on treatment and on drugs are probably the most likely to infect others. It would seem kind of crazy to deny meds to people who failed a drug test...

These results came out earlier this week so I would assume if anyone were to contact me about my drug test results they would have already. I'm also thinking there's a chance it might have been an accident. This was for my yearly checkout where they literally test everything.

[mitch777]

I can't remember exactly how long since I tested as UD but I'm guessing since 1996. There have been 2 blips along the way. Don't worry.

I would be more focused on celebrating your great numbers! Yay!

[texaninnyc87]

Update:
My labs taken mid january came back UD! so I suppose the last reading was a blip. My CD4 did drop to 480 (31%) which is a bummer since it was so high! but oh well.
cant win them all i guess.

[wolfter]

Update:
My labs taken mid january came back UD! so I suppose the last reading was a blip. My CD4 did drop to 480 (31%) which is a bummer since it was so high! but oh well.
cant win them all i guess.

Looking at your trends, I'd surmise that your high CD4 count was a blip.  I had one result that my doctor immediately dismissed because it didn't seem logically statistical. 

[Buckmark]

Update:
My labs taken mid january came back UD! so I suppose the last reading was a blip. My CD4 did drop to 480 (31%) which is a bummer since it was so high! but oh well.
cant win them all i guess.

My (relatively) new HIV doctor explained that how the body manufacturers CD4 cells naturally leads to a variation in levels.  The body produces and releases these cells in batches, then rests and manufactures more.  If you get a blood draw shortly after your body releases a new batch, your CD4 count will naturally be higher.  That's why it is longer-term trends which matter more than an individual test.

I had never had it explained to me this way before.  There's no way to know when your body is releasing a new batch of CD4 cells, and thus no way to time your tests.  Perhaps someone needs to come up with a CD4 "ovulation" home test.   

Henry

[texaninnyc87]

That's interesting. I'd never heard that before. Maybe I just got someone else's labs entirely? Ha

[YellowFever]

Y'know, there was this whole talk in the research/clinical circles about the stressful effect frequent CD4 numbers could have on patients. And although sometimes I envy the Americans who get to find out about their CD4/VL/whatnots every week if they so wished, I am occasionally grateful that I don't have such a luxury...

And the truth is, I usually worry about my CD4 counts in the month running up to the blood draw ("shit is this runny nose going to tank my CD4?") and in the month after getting the results ("WHAT DOES THIS ALL MEAN!! *blink*blink*). So I get a good amount of peacetime in between when I don't/can't think about my CD4 numbers.

[wolfter]

Say what?  I've been dealing with hiv for 20+ years in addition to watching all my close friends also deal with it.  We never had the need/want for weekly testing.  3 times per year is plenty, and I'm about to switch to every 6 months.

[pittman]

I wondered if it were tied to a public funded clinic/situation as well. I sure hope that's not the case!

They always ask about alcohol and recreational drug use at my doctor's office, but no testing. The only normalized screening is for STIs, though for that they inform you that is the plan. I think you can say no if you choose.

What I did find, however, was some online references to programs to normalize drug screenings as a way to identify those that may need referral to treatment.  I am not so sure it's a good idea! though the program literature claims a significant reduction in drug abuse. I would wonder how that is effectively measured, given you often know when you will go to the doctor.

I think the implications for privacy and for retaining some control over your own medical care could be troubling.

http://www.samhsa.gov/samhsanewsletter/Volume_17_Number_6/NormalizingScreening.aspx