Author Topic: Start treatment ASAP in Thailand ? (Read 7393 times)

INGV · « **on:** June 30, 2016, 01:23:59 am »

Hi all,

I am Vietnamese, pos diagnosed from June 2016. I really feel depressed but finally I had to get up for living. I did the other tests after one week of mental crisis. And the result is:
- CD4: 538
- CD8: 1770
- %CD4: 19.9%
- My HBV-DNA is 177 cps/ml and seem not active.

I would like to ask my %CD4 is lower than normal range. Is it temporary after a week of careless of health or is a sign of illness ? Need med treatment right away?
I have acuting HBV so my med option will be less ? Since I read that Stribild and Atripla are not approved for heps B. I wish i could take as less pill as possible in my treatment.
I plan to go Thailand for health test and prescribed for drug treatment because I found that my country mostly provide old drugs model and I would have to take many pills per day. I would like to know if my case is accepted ?
I am looking forward to hearing advices from you all...

Thanks alot

mecch · « **Reply #1 on:** June 30, 2016, 08:12:18 am »

Hello
Sorry you got the HIV! Welcome here.

None of us are doctors so take any info with a critical eye especially before you see a doctor.

1) Nobody can tell you if your CD4 is in the "low range" because we don't know your CD4 level before infection. Probably you don't either. 538 is fine - not a crisis at all!

Use to be 5-10 years ago, in the rich countries, doctors would generally start treatment when the CD4 fell below 500. Now many rich countries just try to treat on diagnosis, no matter the CD4 number.

2) As for Atripla and hep B - the two "truvada" drugs in Atripla - emtricitabine and tenofovir - are in fact active against HBV. The caution prescribing Atripla to a person with HBV would be if there is any liver acute or chronic liver "problems". So that would be for a doctor to figure out in your case.

I don't know what you meant by your phrasing: "Stribild and Atripla are not approved for heps B". The molecules above are active against HBV but I don't think they are considered a "treatment for Hep B" they are HIV treatment. The molecule that is sometimes prescribed for Hep B is entecavir. I know people who got entrecavir PLUS atripla. So Atripla is used for HIV+ people with HEP B. Maybe atripla is avoided as the HIV treatment, if there is a liver problem, as stated.

3) I personally have no info on Stribild nor any experience with it.

Good luck with a doctor consolation in Thailand, sounds like a good idea to me if the drugs are better there than Vietnam.

INGV · « **Reply #2 on:** June 30, 2016, 08:46:31 am »

Hi Mecch,

Thank a lot for your useful information. It reduces the worry and obssession existing for weeks.

Maybe I got misunderstand about the drug Atripla when it states "not approved for treatment of HBV". I thought that it is not applicable to patient who has HBV inflammation due to cause liver damanged as side effect.

About my country, I have refer to latest updated drug list for HIV treatment (2014), I found that mostly old lines drug which need to combine many bills for a day. Moreover, sorry to say but the treatment service as well as experts in meds is still new compared to neighbor countries. It really worries me. Thus, I did ask about treatment service in Bangkok since I just want to ensure I will get the right advices, right presciption.

One last question, I ask about my current status. Should I be on meds soon if I can afford ? Or just wait for next tests and decide? How is life expectancy from now. I am 29 yrs old now..

Many thanks

mecch · « **Reply #3 on:** June 30, 2016, 09:05:41 am »

Hi
You can read the HIV/AIDS Basics on this site - for treatment info, etc. Look at the top of the page.

Again, I am not a doctor and won't say if you should be on treatment now or 6 months or whatever. I told you what they did for years, and then I told you what they are doing now - the national recommendations in so called rich countries. The most current science suggests for several reasons, treatment soon after diagnosis for everyone is best. That does not mean waiting is all that damaging - it depends on the individual case.
In the UK I think the National Health service is still NOT treating at diagnosis, and waiting for below 500. So if its good enough for them....

The current life expectancy is fine - near normal - you should plan for a long life and save money for financial security when you will be old.

For the UK, the studies are starting to suggest maybe a LONGER life span (on average - for a population) for HIV+ than HIV-. The hypothesis is that HIV+ people get more care and regular care and so over the years their health may be better than people who neglect to see doctors and get treated late for various conditions.

BKKKevin · « **Reply #4 on:** June 30, 2016, 10:25:08 am »

Here are a few really good web posts on treatment in Thailand:

http://pozboysg.tumblr.com/post/36344282081/bens-letter-seeking-hiv-treatment-in-bangkok

http://pozboysg.tumblr.com/post/37181001620/an-update-on-bens-experiences-getting-hiv

Here is a link to the Red Cross that shows the prices and drugs available... You can buy a 6 month supply with a prescription for any doctor (even your Vietnamese Doctor as long as it is written in English...

http://www.adamslove.org/en-d.php?id=73

Overall the Thai system is great!... Doctors are supportive and the Red Cross is a great resource...

INGV · « **Reply #5 on:** June 30, 2016, 11:13:16 am »

Much appreciated for above useful information. Feel like I am not lonely in this world anymore.

Could I ask if Red Cross Bangkok provide consultancy/advice on treatment or give prescription base on related test results ?

Thanks

BKKKevin · « **Reply #6 on:** July 01, 2016, 09:15:33 pm »

The Red Cross has a free clinic on site but my guess it is geared for Thais... So they would most likely not be able to communicate effectively in any other language... And they are most likely set up to only confirm HIV status and if you are positive they would refer you to a government hospital (which is free for Thais)... There they would undergo further testing and treatment.

If you are looking for a detailed consultation I would recommend Bumrugrad as they speak perfect English...

And as I said before if you have a doctor in your own country they can write a prescription (in English)... And take it to the Red Cross in Bangkok and get a 6 month supply of meds..

terrymoore · « **Reply #7 on:** July 02, 2016, 02:08:05 pm »

Hi,
Sorry about your diagnosis. It is good your are at this site - it is a great resource for support and information. And, no, you are not alone! :-)
I pm`d you some info. As BKKKevin wrote, the Redcross is a great place. I actually DID get to speak with a councilor there and her English was fine. Having said that, if you can afford it, i would see Dr. Anuwat at Bumrungrad Hospital - he is really great.
Good luck and be cooooool!

mecch · « **Reply #8 on:** July 07, 2016, 12:31:37 pm »

Hiya - this what you asked in PM but I feel that I can answer these questions in public.

INGV: Thank you for your provided information in my own topic and sorry to bother you again since I am still in a mess of concerns.

As recent studies stated that hiv meds can help patients live a long life span. However, I still wonder if it comforts us or it really work? In actual, how many years in average we can expect since diagnosed?

MECCH: HIV treatment really works. I really don't understand how you can doubt this. HIV treatment is working for millions of people around the world.

As for average years of life after diagnosis, this is something that you must stop worrying about and stop comparing. All the doctors are saying "near normal lifespan" if a person is properly treated for HIV and maintains the treatment for life, or until something else comes along in the LONG DISTANT future.

INGV: About hiv meda, when starting to be on meds, will our health will be normal like pre-diagnosed or hiv-related illness will still come but just slowly?

Sorry for asking too much, i just still too scared. Can you share your real experiece so I can prepare spirit in advance....

Thanks

MECCH - no problem INGV asking questions. Listen everyone is different. For example, some HIV+ people go for 10 or more years before they are even diagnosed. Do you EXPECT they are going to have the same experience once treated, as someone who is diagnoses pretty early after infection and starts treatment? And even in that scenario, there are no guarantees.

If you got your diagnosis soon enough after infection, and if you take medicine, and go to undetectable and stay there, you are not going to get AIDS. Did you read the lessons on this site, and elsewhere? What did your doctor tell you. Maybe doctors in your country or your own doctor isn't a very helpful person. My doctor said "LIFE AS USUAL" and I was up for a big promotion and he said "LIFE AS USUAL - Plan everything and do everything as you expected." "You are not going to get AIDS and get sick and die of HIV".

That was my doctor. I don't know what your doctor says and I am not here to play intellectual games about what is the "AVERAGE EXPERIENCE" because I, personally, think that is absolutely worthless to someone like you.

If you INGV get on treatment, get undetectable, and stay on treatment, the common experience of someone "like you" (NOT YOU! - nobody can predict what will happen to the individual YOU) is that you will never get AIDS. Can you put that to rest now?

Maybe 20 or 30 years from now you might have some health things that go along with long term HIV+. ITs very difficult to judge that now. But that is hardly the priority NOW, for your living, and who the fuck knows because its 3 decades away from now.

mecch · « **Reply #9 on:** July 07, 2016, 12:38:33 pm »

So in summary here is my message.

INGV - HIV treatment works very very well. It is based on research science, medical practice and is used by millions. There is nothing to be afraid of it.

IMO a priority for someone who is HIV+ is to trust that medical science knows how to treat this, and thus to start the best treatment possible, and to organise one's life so that treatment is never a risk.

2nd priority is once that is in order - go about making one's living and one's social life and love life. Especially young people. You must not get fatalistic about being HIV+ and think your health and life are ruined. You must go out there and build your career and your life and be sure to save for old age.

Expat1 · « **Reply #10 on:** July 07, 2016, 06:34:38 pm »

Hi.
Welcome to the forum.

I live in Thailand. Recently the Thai Red Cross checked the quality of medicines in hospitals and clinic in the South East Asia Region. All drugs checked were real. One of the samples was from Viet Nam. It was an Atripla generic. (Not sure which.) Teevir is the generic Atripla used in Thailand. There are others. It costs about 1000 baht here.

So drugs that comprise Atripla are availiable in Viet Nam.

If you do come to Thailand. Bring your test results so that you do not have to redo all the tests. Also a prescription from your doctor, his licenses number and the hospital he is affiliated with. If those conditions are met, they Thai Red Cross can give medicine. 30 pills is one month. Most people start with a single 30 day supply to make sure that the medicine is ok for you.

The doctor likes to see you after a week or 10 days to check liver enzmyes. ALT AST and kidneys.

Most people in Thailand Start antivirals without a genotype test. It will take a week or two to get results if you want it.

Plan on getting a Viral Load test about 8 weeks after you start meds. That way then can see if you have a good response. (Important if you dont get the genotype test). To make sure the drug is working.

Teevir is one pill a day same as Atripla. And it contains same ingredients.

I also have Hep B (previously cleared not chronic). It was what I started on and it is active against Hep B. If you stop the medicine the Hep B virus can flare and inflame the liver. So you want to make sure you can get a steady supply of the medicine.

Good luck.

shizukav2 · « **Reply #11 on:** July 21, 2016, 08:17:38 am »

I was diagnosed +ve at Bangkok General Hospital - and the doctor i was referred to advised waiting for treatment until the viral load increased and/or CD4 dropped... ie i was given old out of date advice...

Fortunately, my best friend works in the Pharmaceutical business, running clinical trials... and is Thai (although now living working in US) - so he not only put me straight on starting treatment immediately but gave me names on these three following Doctors in particular :-

1. Dr Kulkanya Chokephaibulkit, Siriraj Hospital
- Contributes to the HIV treatment guideline in Thailand and collaborates with CDC in Atlanta.

2. Dr Praphan Phanuphak, Bumrungrad Hospital
- Director of HIV-NAT
- Diagnosed first HIV cases in Thailand and has pioneered many initiatives for treatment, infrastructure etc for patients, caregivers, relatives.
- See https://www.bumrungrad.com/doctors/Praphan-Phanuphak

3. Dr Torsak Bunupuradah, Thai Red Cross AIDS Research Centre (HIV-NAT)
- A key research center for many drug companies
- See http://en.trcarc.org/

Personally, I'm seeing Dr Praphan at Bumrungrad - I will also point out he was more than happy and was first to 'offer' or 'point out' that for the medication (Atripla, or actually the Indian made version of it - note, choice was up to me ie I could choose the Atripla but the Indian made Teeveer is the same drugs..) I could chose to go to the Thai Red Cross for it ( I have medical insurance, lucky me).

Had frequent check ups at first to ensure the kidneys were ok with the medication, the fairly common skin rash came and went... and after a few months am at undetectable levels of viral load.

So - you should start treament asap and have regular checkups initially to ensure kidneys etc are ok with the medication.
You can purchase the drugs at the Red Cross - just for comparison sake, at Bumrungrad from their Pharmacy... in other words very much 'full price' (!) Teevir(Atripla) the one a day pill is around 2800 baht per 30 pill bottle.

terrymoore · « **Reply #12 on:** July 21, 2016, 04:02:44 pm »

Hi Shizukav2 and nice to meet a fellow Bangkok-ian

I was wondering, when you wrote:

Quote

( I have medical insurance, lucky me).

What do you mean? Does your insurance cover your HIV treatments? If yes, may i ask which you are using? I use BUPA and from what i know, they do not.
Thanks!

shizukav2 · « **Reply #13 on:** July 22, 2016, 12:10:20 am »

Quote from: terrymoore on July 21, 2016, 04:02:44 pm

Hi Shizukav2 and nice to meet a fellow Bangkok-ian

I was wondering, when you wrote: What do you mean? Does your insurance cover your HIV treatments? If yes, may i ask which you are using? I use BUPA and from what i know, they do not.
Thanks!

Yes - my health insurance covers everything ( to some number of milllions of dollars in the US but unlimited outside). It is with CIGNA, but have had BUPA before - both through work and both 'expat' ie foreign health insurance not Thai - I had heard that Thai private heath insurance doesn't cover HIV, which strikes me as an absolute disgrace and should be illegal.

terrymoore · « **Reply #14 on:** July 22, 2016, 05:10:19 pm »

Shizukav2,
May i PM you regarding this?

shizukav2 · « **Reply #15 on:** July 23, 2016, 07:23:21 am »

Quote from: terrymoore on July 22, 2016, 05:10:19 pm

Shizukav2,
May i PM you regarding this?

Sure - just ot pont out the 'obvious', different plans cover less or more and having deductibles etc will make the insurance cost much lower.

I happen to be in th fortunate position of health insurance through my employer, and because many are living outisde the US, coverage is that much more wide.

Mindless · « **Reply #16 on:** August 02, 2018, 10:16:10 am »

Hi guys,

sorry to jump in but I’m pretty much interested in this insurance issue: living in Thai as an expat and having a company’s insurance that doesn’t cover hiv meds. May I get some more info?

Thanks

Quote from: terrymoore on July 21, 2016, 04:02:44 pm

Hi Shizukav2 and nice to meet a fellow Bangkok-ian

I was wondering, when you wrote: What do you mean? Does your insurance cover your HIV treatments? If yes, may i ask which you are using? I use BUPA and from what i know, they do not.
Thanks!

Gladragsguy · « **Reply #17 on:** September 08, 2018, 11:26:45 am »

If anybody knows of any private insurance companies that cover HIV in Thailand please post them...though pretty sure it's too late for us now as it would be considered a pre-existing condition. BUPA/AETNA Thailand does not and they specifically ask you about it before signing up for coverage...

Expat1 · « **Reply #18 on:** September 08, 2018, 12:02:48 pm »

I believe that it is an exclusion on all local Thai policies. It was excluded on my Thai BUPA and Thai Health Ins. companies policies.

INGV · « **Reply #19 on:** September 12, 2018, 12:06:20 am »

Hi all,

Just quick update. After 3 years since the date of knowing infected, I decided to go Bkk for treatment. Before the treatment I did the new labs and the result is:
CD4: 806 (before it was 536)
CD8: 2200 (before was 1800 sthing)
virus load: 406 (no test before)

Doctor was surprised and said my immune controlled and against well the virus even before treatment. However, for new guideline I need to start treat regardless of CD4 number. I have been descripted 2 bills a days which is used for low virus load and high cd4, very low cost (100$/month) and no much side effect like Atripla or others.

I am still waiting for my drug resistance test before starting take medicine. Hope everything is fine.

Thanks all for all your kind advices and supports.

Cheers

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Author Topic: Start treatment ASAP in Thailand ? (Read 7393 times)