Meds, Mind, Body & Benefits > Questions About Treatment & Side Effects

Very disappointing 1st Labs - Should I be alarmed??

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BeachNYC:
I started Truvada, Reyataz and Norvir on May 13 (I'm resistant to all non-nukes, though this is my first regimen.) First labs were taken May 30, and I received my results today. CD4s dropped from 186 to 117, VL increased slightly from 52,000 to 56,000. I am so disappointed, especially after having read so many posts explaining that these drugs do most of their work in the first few days or weeks. My doctor says that he is not alarmed (he is a prominent HIV Specialist here in New York City), that he's seen it take a while for the drugs to kick in. He took my blood again today, and said we'd look at it again in a month, and decide how to proceed from there. He is also doing another resistance test.

But I'll be honest, I'm really scared. I have tolerated this regimen extremely well, but maybe that's because they're not doing anything!

Do others in these forums have any idea as to just how concerned I should be? I know that I should trust my doctor, he does this stuff all day long, but I just had such very different expectations.

Any help will be appreciated.

Thanks,

Robert

Christine:
Hi Robert,
Try not be to concerned over one test result. It is the over all trend of your labs- t-cells, vl, and especially the %. Some people respond slower to the meds. I think your doctor is right on target. Another set of labs, then make any decisions then.

For now, try to keep stress levels low (easier said than done, I know), eat healthy foods, get plenty of sleep, and if need be go talk to a counselor or a group. Hang in there.
Christine

lydgate:
Hey Robert,

Totally agree with Christine. Also, there's no real difference between your viral load numbers; they're essentially the same. In fact, given that your first VL was roughly 50K, for the next result to count as biologically significant, it needed to be below 17K or above 150K -- i.e. changed at least by a factor of three, either up or down. (This is what the scientists call "assay variability.") As for CD4, the more important number is the percentage rather than the absolute count, which can vary a lot. The percentage tends to be more stable over time and its trend upwards or down is a better marker of your immune sustem's health. So the Science behind the two sets of numbers is telling you: don't worry, certainly not yet. And try to remember that some people respond to meds, of whatever kind, really quickly and other people take a bit longer.

Hope that helps somewhat. If you're still feeling mega-stressed, consider asking your doc for a short-term prescription to an anti-anxiety medication. I certainly did after my diagnosis, and it helped me (but then, I'm pretty comfortable popping pills for any kind of pain).

lydgate

dirtycar74:
Levels, especially VL and CDx counts, can vary so widely that the difference between tests (exact numbers, not percentages) can almost be irrelevant.  It's the trend that the doctors are basically after.  The first pre-HAART lab should give you a "before" picture and the rest will be kinda like benchmarks to let you and your doctor monitor your progress toward the eventual goal (being undetectable)...  Non biologically significant fluctuations of cell counts, etc (less than a three-fold change in either direction) in a single event, without severe negative episodic symptoms, shouldn't be much of a worry, as far as I understand.  But then again, I'm no doctor. 

If you have a good doctor, and you trust him or her, I'd highly recommend you talk this whole thing over with him/her.  Also I highly recommend you think about seeing a Social worker or therapist (no, they're not just for the crazies, you know!) if your medical coverage provides it.  Kaiser (my plan at least) does, and I have taken myself into the SW to chat when I was overly worried and stressed out.  I also recommend consultation with a dietitian and pharmacist as well since some treatment regimens can make drastic changes to your appetite and your diet can be adversely affected.  It's no fun to get sick from the pills you have to take to keep you from getting sick!  Just my $0.02 here though...

newt:
Hello Beach

This is a pain in the arse set of numbers

Viral load results vary by a factor of 3 - could be 3 x greater or 1/3 - this is the limit of test.  You nos could mean that the first set was higher, up to 150k and the second set lower, down to 15k, which would be right given your few weeks on meds.  But there's no way of telling.  Pain the arse. (It's unlikey to be the other way round - first result lower, second higher - even if you had some undetected nuke/PI resistance, you would expect some downward movement at the start of treatment. 

Get a retest.

- matt

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