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Author Topic: Thailand  (Read 22894 times)

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Offline Mindless

  • Member
  • Posts: 362
Thailand
« on: March 26, 2017, 01:04:41 pm »
Hi everybody,

I'm a westerner living in Thailand (came here for work a couple of years ago), just discovered to be positive about 5 weeks ago and started medication (they gave me Atripla) the next week after the routine blood tests.
I didn't actually look for an HIV specialist but just went to same hospital where I was tested and where I used to go for any kind of "silly" health problem (flu or other). I'm not so young anymore (around 50) and I've been taking medications for a depression condition I've been fighting for at least the last 25 years of my life. When I was finally starting to think to get rid of all that "chemical stuff" (Wellbutrin, Zoloft, Seroquel) I discovered that at my not-so-young-age-anymore I was stupid enough to have high risk sex and get the virus. A real moron. That's what I am.

After so many years of depression I have no more tears to shed and I came to the conclusion that everyone is responsible for their fate. So, I'm crying inside myself while pretending to go on with my life. I have to work after all.

What I'm looking for here is some advice on how to deal with this (fucking) disease in a country where I don't know almost anyone and of which I don't talk the language. I have a Thai wife (a wonderfull, nice not positive person) I've been married to for many years now but she's a simple person from rural Thailand (as there are many over here). She's the biggest support I have (though I so badly messed up with her) but at the same time, as I said, she's a very simple woman that cannot engage in "complicate" discussions with doctors or seeking advice (moral issues of Thai average people are still a big challenge).

Sorry for being so "desperate". But I actually am.

Thanks

Dx Feb. 2018, CD 320, %14

- Atripla Feb/18 -->
- Complera (generic) 2019 -->
- Dovato (generic) 2021 -->

Offline Ptrk3

  • Global Moderator
  • Member
  • Posts: 2,792
Re: Thailand
« Reply #1 on: March 26, 2017, 01:18:53 pm »
Mindless:  I'm sorry to read of your recent diagnosis, but glad that you have started a medical regimen and that you have found these forums for ongoing support and enlightenment.

I don't live in Thailand, so can't give you local advice, but there are people on these forums in Thailand, so, perhaps, they may chime in and direct you to some local resources.

In general, though, I can assure you that you will be fine, provided you remain adherent to your medical regimen (I, too, am on Atripla) and look after yourself:  you will live a long and healthy life.

Also, peruse these forums, as they provide a long history of people successfully dealing with a HIV diagnosis.  Many of their stories are inspirational and can help you find the support you need.  Likewise, become an active member of this forum and share with us your ongoing journey because helping others does help you, too.

Best wishes to you as you move forward to continued good health, success, and peace of mind.
HIV 101 - Basics
HIV 101
You can read more about Transmission and Risks here:
HIV Transmission and Risks
You can read more about Testing here:
HIV Testing
You can read more about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read more about HIV prevention here:
HIV prevention
You can read more about PEP and PrEP here
PEP and PrEP

Offline Mindless

  • Member
  • Posts: 362
Re: Thailand
« Reply #2 on: March 29, 2017, 09:28:12 am »
Thank you for your kind words Ptrk3.

In these days I'm feeling so desperate and with no power... I'm just hoping not fall back in the black hole of depression I had started to climb up years ago.
Feeling sad for myself and becoming aggressive to people around me who have nothing to do with my problems or with my faults.

M
Dx Feb. 2018, CD 320, %14

- Atripla Feb/18 -->
- Complera (generic) 2019 -->
- Dovato (generic) 2021 -->

Offline Ptrk3

  • Global Moderator
  • Member
  • Posts: 2,792
Re: Thailand
« Reply #3 on: March 29, 2017, 11:17:40 am »
Always remember that things do get better and that the illness of depression can distort your outlook.  Also, be mindful that the Efavirenz component of Atripla can exacerbate depression in some people.  If you feel that it does, speak with your healthcare provider and discussing switching to a different regimen:

http://www.beyondpositive.org/2013/10/25/luke-atripla-mental-health/
HIV 101 - Basics
HIV 101
You can read more about Transmission and Risks here:
HIV Transmission and Risks
You can read more about Testing here:
HIV Testing
You can read more about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read more about HIV prevention here:
HIV prevention
You can read more about PEP and PrEP here
PEP and PrEP

Offline Mindless

  • Member
  • Posts: 362
Re: Thailand
« Reply #4 on: March 29, 2017, 12:10:57 pm »
Hi,

I am aware of this possible side effect of Efavirenz (I read some stuff on the web, by the way the one you linked is quite creepy  :-[) and I already expressed my doubts to the dr. who prescribed me Atripla (who's basicallly an infectious deseases doctor, not an "HIV" specialist). The answer was simply that the alternative would be to get a huge number of different medications instead of only 1 pill and that I may be over-worried since I just started the therapy. So, he suggested me to talk to a psychiatrist to possibly adjust the dosage of the depression medications I'm taking. Nevertheless, this doctor has been kind and encouraged me saying in Thailand HIV is quite well known and well treated. So, he gave me some faith in the end.

Therefore I went to meet 2 psychiatrist, the first ones I found, because as I said, I don't have connections here (besides, I don't want to disclose my health issues to acquaintances or, even worst, to coworkers) but the impression I got was they barely know HIV mental related issues (one of them even offered me to download his Android application about "Mental Health Holistic Approach" or something  :-[) and basically both of them did what I'd done by myself: checking interactions and side effetcs on the Internet... yes, just like that.

So, I ended up thinking the best I can do is continuing Atripla hoping the side effects will vanish eventually: I have added some Ritalin, prescribed by one of the 2 phychiatrists (the one who managed to inspire me a little more confidence). Ritalin (which is a mild stimulant) helps me to "kick off" in the morning when I'm feeling "scared" by incoming the work day but also gives me a "down" feeling after the 4 hours effect ends.

I don't want go back inside the deperation pit... I don't know what to do now



Always remember that things do get better and that the illness of depression can distort your outlook.  Also, be mindful that the Efavirenz component of Atripla can exacerbate depression in some people.  If you feel that it does, speak with your healthcare provider and discussing switching to a different regimen:

http://www.beyondpositive.org/2013/10/25/luke-atripla-mental-health/
Dx Feb. 2018, CD 320, %14

- Atripla Feb/18 -->
- Complera (generic) 2019 -->
- Dovato (generic) 2021 -->

Offline Ptrk3

  • Global Moderator
  • Member
  • Posts: 2,792
Re: Thailand
« Reply #5 on: March 29, 2017, 03:03:24 pm »
Sorry, didn't mean to "creep" you out--just wanted you to be aware that some folks may have bad reactions to Efavirenz (though the one experienced through the link may be an extreme reaction) so that you know that sometimes it can be the drug that exacerbates depression that may already be present.

Others may have no side effect at all and you may, in fact, be one of these people.

Please take care of yourself and continue to do what you can to avoid the pit of clinical depression, which can really be more deleterious to your health than HIV infection (which these days can be easily treated).

I'm glad that you have a supportive medical team upon which you can rely.  True, some of them may be learning along with you, but keep them close to you to sustain you.  They are on your side, which is a very good thing.
HIV 101 - Basics
HIV 101
You can read more about Transmission and Risks here:
HIV Transmission and Risks
You can read more about Testing here:
HIV Testing
You can read more about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read more about HIV prevention here:
HIV prevention
You can read more about PEP and PrEP here
PEP and PrEP

Offline daveR

  • Member
  • Posts: 289
Re: Thailand
« Reply #6 on: March 29, 2017, 06:51:22 pm »
Hi mindless, sorry to hear about your diagnosis. I feel your pain. I also live in Thailand and was diagnosed here so went through similar things to you. I could not find any help groups, unfortunately Thailand is not to well equipped to deal with mental health issues for locals or expats. I am not sure where you live but it may be worth contacting the Red Cross in Bangkok if it is not to far away, they may know of something. If around Pattaya there is a Dr Philippe Seur. French Dr who is very knowledgeable about HIV and specializes in it. He was very reassuring to me when I met him, although a bit unconventional.
Other than that I would say hang in there, things will get better. Easy to say I know. Try to remember that millions of others are walking a similar path to you and if they can do it so can you. View it as another of lifes challenges which you can and will overcome, just like all others in your life.

Offline Mindless

  • Member
  • Posts: 362
Re: Thailand
« Reply #7 on: March 30, 2017, 11:28:18 am »
I know you didn't Ptrk3,

I'm sure 100%. By the way, thanks for your support.


Sorry, didn't mean to "creep" you out--just wanted you to be aware that some folks may have bad reactions to Efavirenz (though the one experienced through the link may be an extreme reaction) so that you know that sometimes it can be the drug that exacerbates depression that may already be present.

Others may have no side effect at all and you may, in fact, be one of these people.

Please take care of yourself and continue to do what you can to avoid the pit of clinical depression, which can really be more deleterious to your health than HIV infection (which these days can be easily treated).

I'm glad that you have a supportive medical team upon which you can rely.  True, some of them may be learning along with you, but keep them close to you to sustain you.  They are on your side, which is a very good thing.
« Last Edit: April 22, 2017, 11:29:21 am by JimDublin »
Dx Feb. 2018, CD 320, %14

- Atripla Feb/18 -->
- Complera (generic) 2019 -->
- Dovato (generic) 2021 -->

Offline Ptrk3

  • Global Moderator
  • Member
  • Posts: 2,792
Re: Thailand
« Reply #8 on: March 30, 2017, 11:46:45 am »
You're welcome.

Do keep us posted on your progress and developments.

In addition to the public part of these forums, perhaps you can "private message"
member daveR, who also lives in Thailand (once a member posts three times on these forums, he or she is provided the capability to "private message" other members) for more information about resources in Thailand.

Best wishes.
HIV 101 - Basics
HIV 101
You can read more about Transmission and Risks here:
HIV Transmission and Risks
You can read more about Testing here:
HIV Testing
You can read more about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read more about HIV prevention here:
HIV prevention
You can read more about PEP and PrEP here
PEP and PrEP

Offline Mindless

  • Member
  • Posts: 362
Re: Thailand
« Reply #9 on: March 30, 2017, 11:56:10 am »
Hi Dave,

I live in the Bangkok area. Thanks for your message, it's good to know there's someone out there that has been going through a similar path. I agree with you about mental health serivices quality here, at least as far as I happened to try them so far. Probably average Thai people have still other priorities: physical health issues and buying the last iPhone model ;-)

Thanks for your tips: I actually already got in touch with the Red Cross has they sell HIV medications at better prices than hospitals, so my doctor addressed me there to buy mine.

Another concern I have is my health insurance: I guess they gather all the medical informationa about their customers from the hospitals and I have an health insurance paid by the company I work for. So, I actually don't know what to do: I'm scared the Insurance company will inform my employer about my condition (unless they haven't already) and at the same time I fear to ask more information about the coverage, exclusions etc. to them. I fear there will be consequences if I try to claim some expences so after the diagnosys I just paid all my treatments avoiding to submit my insurance data (even for related problems as for example a skin issue). I'm also scared about what could happen when my own company will need to renew my insurance policy in a few months: I'm scared the Insurance Company will increase the premium and/or will refuse to give me a coverage. I'm scared and ashamed and confused: what will happen when they will get to know my condition? It's a small company and everybody knows anyone else.

M



Hi mindless, sorry to hear about your diagnosis. I feel your pain. I also live in Thailand and was diagnosed here so went through similar things to you. I could not find any help groups, unfortunately Thailand is not to well equipped to deal with mental health issues for locals or expats. I am not sure where you live but it may be worth contacting the Red Cross in Bangkok if it is not to far away, they may know of something. If around Pattaya there is a Dr Philippe Seur. French Dr who is very knowledgeable about HIV and specializes in it. He was very reassuring to me when I met him, although a bit unconventional.
Other than that I would say hang in there, things will get better. Easy to say I know. Try to remember that millions of others are walking a similar path to you and if they can do it so can you. View it as another of lifes challenges which you can and will overcome, just like all others in your life.
Dx Feb. 2018, CD 320, %14

- Atripla Feb/18 -->
- Complera (generic) 2019 -->
- Dovato (generic) 2021 -->

Offline Expat1

  • Member
  • Posts: 385
Re: Thailand
« Reply #10 on: March 30, 2017, 02:10:50 pm »
Hi.  I live in Thailand.  I would pay for the medicines out of pocket and avoid insurance issues.  (Since most Thai policies exclude HIV and STD illnesses anyway).  Sad but true.

The cost of Atripla is not excessive and you can use the Generic Teevir instead.  Atripla is a fine drug to start on.  I was on it for 11 months but had to switch as it affected my sleep too much.

Now I take Truvada (generic Recovir EM) and Edurant.  I get them at Pattaya Memorial Hospital a private hospital.  3 months meds and the doctor visit run about 7000 baht. 

If I were in Bangkok I would go to the after hours clinic at Thai Red Cross.  It is cheaper.  I bought 3 months of meds there once for about 3000 baht.  I got a Dr prescription from The Suriwong Clinic near Patpong.   His fee was 500 baht.  I had my lab tests with me.

I get my Lab work at a private lab,  CD 4 is 500 baht and VL is 2300 baht.  I do that every six months.  Regular blood work runs about 500 to 2000 depending on the tests.

Thailand is a pretty good place to deal with HIV.  Better than the US with ACA, ADAP, and insurance hoops to jump through. 

Offline terrymoore

  • Member
  • Posts: 497
Re: Thailand
« Reply #11 on: March 31, 2017, 10:59:43 am »
Hi There and sorry about your recent Dx. You are lucky to have found this site as it is a great source of information and i am sure you will find support here.
I too live in Thailand and in a similar situation as you - around 50, married, she is neg, feel like aa dumbass for taking risks and getting this (fucking!) disease...but here we are, it is what it is and we must move on. Luckily we live in a time where there many med options and we can really live normal (almost) lives. Imagine if this was 20 years ago? Ask the LTS, they will tell you. Also, we are lucky we are in Thailand, a pace where medical treatment is relatively cheap, the meds are very affordable and the people are tolerant. So, in fact, the glass is more than half full!

I started on a regiment of 9 pills a day and then moved to Atripla, however my reaction was bad, so i moved to Truvada (generic Recovir EM) and Edurant too - 2 pills a day. I am not sure why your doctor told you that you will have to take a bunch of pills - it really depends what you must take or if you have limitations i guess, but for me i went from 9 to 1 to now 2 pills a day and it is just fine.
I started at a Doctor which made me feel pretty shitty and after 4 months moved to Dr. Anuwat Keerasuntonpong at Bunmrungrad - he ois very nice, down to earth, non-judgemental and made going to the doc a simple task (before i loathed going to get checked). He recommended me getting my blood tests at teh Red cross and also my meds there since it is so much cheaper.
As per insurance, i too worry, and like Expat1 suggested, i pay cash in order to avoid problems with my insurance - i save my insurance for the heavy duty stuff (i hope that it will never come!). Also, if you worry about your status being revealed, you can make n appointment under an alias and boom - no one knows. I even told my doctor and he is cool with it - after all, this is Thailand.
So, my advice to you is stick to your meds, stay healthy, and be cool. Soon you will be UD and you will just carry on with life. Feel free to PM if you have any specific questions.
Cheers! Terry

Offline Mindless

  • Member
  • Posts: 362
Re: Thailand
« Reply #12 on: April 02, 2017, 07:09:23 am »
Hi Expat1,

thank you very much for your advice and information. It's now about a month that I've been taking Atripla and the starting side effects like dizzyness and slepyness seems a little bit better. Hopefullly they'll go away at all. I'm still very concerned about my mood and other possible long term side effects. My mood is quite blue and I'm confused about many things: should I change medication? Should I change doctor? Should I go back to my home country? Should I... and so on...

Thank you for now, it's good to know there someone out there that's going through similar situation.

M




Hi.  I live in Thailand.  I would pay for the medicines out of pocket and avoid insurance issues.  (Since most Thai policies exclude HIV and STD illnesses anyway).  Sad but true.

The cost of Atripla is not excessive and you can use the Generic Teevir instead.  Atripla is a fine drug to start on.  I was on it for 11 months but had to switch as it affected my sleep too much.

Now I take Truvada (generic Recovir EM) and Edurant.  I get them at Pattaya Memorial Hospital a private hospital.  3 months meds and the doctor visit run about 7000 baht. 

If I were in Bangkok I would go to the after hours clinic at Thai Red Cross.  It is cheaper.  I bought 3 months of meds there once for about 3000 baht.  I got a Dr prescription from The Suriwong Clinic near Patpong.   His fee was 500 baht.  I had my lab tests with me.

I get my Lab work at a private lab,  CD 4 is 500 baht and VL is 2300 baht.  I do that every six months.  Regular blood work runs about 500 to 2000 depending on the tests.

Thailand is a pretty good place to deal with HIV.  Better than the US with ACA, ADAP, and insurance hoops to jump through.
Dx Feb. 2018, CD 320, %14

- Atripla Feb/18 -->
- Complera (generic) 2019 -->
- Dovato (generic) 2021 -->

Offline Mindless

  • Member
  • Posts: 362
Re: Thailand
« Reply #13 on: April 02, 2017, 07:48:08 am »
Hi terrymoore,

thank you for all your advice, it's very precious to me since I got my diagnosys only a few weeks ago and I felt like a complete failure.

Yes, one of my (many) concerns is the health insurance (paid from the company I work for), so me too I started to pay for my doctors and medications without claiming the insurance. On the other hand, it may too late now: until the diagnosys I didn't think about this problem (and I was too shocked soon past it), so at least the fisrt times I gave my insurance data to the hospital without realizing it could be a problem. Besides, I always went there on my real identity since at the hospital they use to ask me an ID before accepting me. By the way, you say you go to the hospital using an alias: can I ask you how do you do? How do you bypass the ID check? (I learnt that you can answer me privately now if you can't do it publicy).

Since then, yes I payed my doctors and medications (there's no alternative anyway). I feel afraid and ashamed that the insurance company knows about my condition and they will (or already have) tell my employer (that in time means everybody will know). Even before the diagnosys I was thinking to change my job, now I'm too worried about my situation to think about job changes. Now everything seems so much more complicate: if I changed job and they offered me an health insurance I would be obliged to tell them I'm HIV+ and that would add to the difficulties.

I'm really not feeling happy with my life now, the issues are so many and so big that I feel overwhelmed. I know from experience what that means: it means I'm facing a depression, something I've been fighting the last 25 years of my life and from which I was trying to escape.
Moving to Thailand and completely changing my life (along with medications and long therapy behind my shoulders) was part of the plan. Now I'm not sure of anything anymore.

Thanks again for your interest and your kind words.

M


Hi There and sorry about your recent Dx. You are lucky to have found this site as it is a great source of information and i am sure you will find support here.
I too live in Thailand and in a similar situation as you - around 50, married, she is neg, feel like aa dumbass for taking risks and getting this (fucking!) disease...but here we are, it is what it is and we must move on. Luckily we live in a time where there many med options and we can really live normal (almost) lives. Imagine if this was 20 years ago? Ask the LTS, they will tell you. Also, we are lucky we are in Thailand, a pace where medical treatment is relatively cheap, the meds are very affordable and the people are tolerant. So, in fact, the glass is more than half full!

I started on a regiment of 9 pills a day and then moved to Atripla, however my reaction was bad, so i moved to Truvada (generic Recovir EM) and Edurant too - 2 pills a day. I am not sure why your doctor told you that you will have to take a bunch of pills - it really depends what you must take or if you have limitations i guess, but for me i went from 9 to 1 to now 2 pills a day and it is just fine.
I started at a Doctor which made me feel pretty shitty and after 4 months moved to Dr. Anuwat Keerasuntonpong at Bunmrungrad - he ois very nice, down to earth, non-judgemental and made going to the doc a simple task (before i loathed going to get checked). He recommended me getting my blood tests at teh Red cross and also my meds there since it is so much cheaper.
As per insurance, i too worry, and like Expat1 suggested, i pay cash in order to avoid problems with my insurance - i save my insurance for the heavy duty stuff (i hope that it will never come!). Also, if you worry about your status being revealed, you can make n appointment under an alias and boom - no one knows. I even told my doctor and he is cool with it - after all, this is Thailand.
So, my advice to you is stick to your meds, stay healthy, and be cool. Soon you will be UD and you will just carry on with life. Feel free to PM if you have any specific questions.
Cheers! Terry
Dx Feb. 2018, CD 320, %14

- Atripla Feb/18 -->
- Complera (generic) 2019 -->
- Dovato (generic) 2021 -->

Offline terrymoore

  • Member
  • Posts: 497
Re: Thailand
« Reply #14 on: April 02, 2017, 09:26:25 pm »
Hi,
Firstly let me say again, we are very lucky that we have caught this in 2017 (and not in the 1980`s) - we have a large variety of med options and if we adhere and live healthy lives, then we can expect a relatively normal life! My point to you is, be cool, be calm, take your pills, and you will be fine.

Now let me address your points:

Quote
so at least the first times I gave my insurance data to the hospital without realizing it could be a problem
- same with me. And since then i have renewed my policy 2 times and no issue. Luckily for us, the insurance companies don`t always work efficiently here, and unless it is something really costly, i think they overlook it.

In the worst case, if they DO find out, i doubt they will tell your employer - it is a breach of their confidentiality laws and i doubt they will risk being sued. And, in the case that your employer does find out, again, this will not be something that your HR spreads around. You would be surprised how many POZ people there are, or people with HEP or other conditions. Thai`s tend to be very discreet and i believe it will be business as usual. In fact, the reaction i have received is that of sympathy on the lines of "oh...so sorry for you...bad luck..mai pen rai, you will be ok..."...
And...in teh worst case that everyone finds out and "outs" you - so what? Will life change? I doubt it. Friends will be afraid at first but you will explain and educate them and the good friends will stick around and the rest - well they are not worth it.
I do not intend on belittling your worries - they are real and justified. However, looking at the big picture, you will be healthy, you will live a long life, you will enjoy great foods, meet nice people, love, have sex, grow old etc etc - not such a bad deal for what once used to be a certain death sentence.

costs - since you are paying for your own medical expenses now, i suggest you try and reduce them as much as possible to reduce the burden. The Red Cross sells original and generic meds at a subsidized price which is significantly cheaper than buying at the main hospitals - almost a 5th of the price. You can also get your blood check ups there. I get my VL and CD4 done there as well as my CBC (Complete blood count is given for free if you do the CD4 and VL test). My doctor at the private hospital uses those results and writes prescriptions to use at the Red Cross. If you do not want to use a private doctor because of the cost, the Red cross also gives full doctor services so you can do everything there, including COUNCELLING (i suggest you consider). Here is their website and there is lots of info there -
Thai Red Cross Anonymous Clinic http://en.trcarc.org/?page_id=632

Another useful website with good local info on their webboard is  Adamslovehttp://www.adamslove.org/en-index.php

Regarding your question
Quote
By the way, you say you go to the hospital using an alias: can I ask you how do you do?
- I simply showed up, said i want to see a doctor, they asked if i have a hospital card, i said NO, and when i registered and they asked for ID, i told them that i forgot it at the hotel and will bring it at my next appointment. Done! These private hospitals do not really care. I have done this many times. Check your private messages for more info.

One more thing - i used to take Atripla - it is very popular here and has worked wonders for most. However, in my case, i had a bad reaction and it made me feel depressed and strange. I switched and my world went back to normal. I am not saying this is your case, but from what i have read, people who are prone to depression etc should seriously consider changing regime. I am not sure if you discussed this with your doctor. If you have not, you should. Again, Atripla is a great med for most people who take it, but you should make sure it does not affect your depression.


So, be cool and take care. Take your meds and STAY HEALTHY! If you ever have any questions, feel free to PM me. Cheers!



Offline Expat1

  • Member
  • Posts: 385
Re: Thailand
« Reply #15 on: April 10, 2017, 01:39:09 am »
My doctor wanted me to stay on Atripla for a year.  It is much stronger than Truvada and Edurant. Also the EFV part can cancel the Edurant part in a switch so you have to be undetectable before the switch.   Later I found out that many doctors  want you to be on it for at least six months. 

In any case if you are not having debilitating problems you might want to stick it out a bit more.  I dont know if you posted your viral load before, but Edurant not for people with VL above 100000.  There is debate regarding if that holds for someone switching who is now undetectable but was above that number.

Also Edurant must be taken with a full meal.  One you chew not drink.  And it needs an acid stomach environment so if you take proton pump inhibitors (like Nexium) you will not be able to take it.  Also if you just take antiacid tablets (TUMS) the timing needs to be adjusted so that you dont take them with the ARV meds.

My partner take a 400 mg dose of EFV rather then the 600mg dose.  That could be another option. If the dreams and sleepyness dont resolve.  (So he takes Recovir EM and two  200mg EVF pills= total of 3 pills.)

Atripla was really effective at lowering my VL from 43000 to 160 in just 17 days.  So again, really strong drug.

Offline Mindless

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Re: Thailand
« Reply #16 on: April 22, 2017, 09:32:29 am »
Terry, Expat1,

thank you so much for your kind advices (you don't know how much I appreciated them) and sorry for my long "disappearance". My only "excuse" is that I'm actually being pushed back into a deep depression, which I was fighting since a very very long time ago, and even reading this forum has become in some way "painful".

Anyways, thank you again for your great advices and thoughts, I hope I can reply to each of your comments with more time and words soon.

M
Dx Feb. 2018, CD 320, %14

- Atripla Feb/18 -->
- Complera (generic) 2019 -->
- Dovato (generic) 2021 -->

Online Jim Allen

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Re: Thailand
« Reply #17 on: April 22, 2017, 11:30:39 am »
Take it easy and things will be okay.

Jim
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Offline terrymoore

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Re: Thailand
« Reply #18 on: April 22, 2017, 01:12:33 pm »
Hi,
Take it easy bro. Go for a walk in the park, go to a gogo bar, drive to the beach, get some good street food, get a foot massage - so many choices and reasons to be happy. Life is great! Take your meds, get into a routine, you will be fine. Tell your doc about your depression - see what he says.

Offline Mindless

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Re: Thailand
« Reply #19 on: May 27, 2017, 08:25:18 am »
Thank you All,

for your kind words and in particular Terrymoore, Ptkr3, Jim for all the very useful advice.

I think I owe you at least an update: since I started my therapy with Atripla 3 months ago I told my doc that I wanted to check my blood count and VL (for some reason he was going to wait I don't know how more time).

Also, I eventually got to know the figures of my first blood count 3 months ago (end of February): CD4 320, CD% 14, VL 175,000.

When I saw these numbers I was astonished: I thought I had just been having ARS last December when I was admitted at the hospital for what, at the time, I thought was just a stronger than usual flu. So I can't make sense of them... may I have been infected much much longtime ago?

Also I lost almost 10 kg since then (more than 10% of my body weight).

Anyways, last check 1 week ago was: CD4 561, CD% 21, VL 333

I see many people reporting that after only 1 or 2 months of medication they are already undetectable, so I'm still a little worried but the doc looked satisfied.

On the mental side: the depression is still there but I'm fighting with my teeth and nails to not letting it taking me down. I force myself go to work even when I wake up in tears and keep working as much as possible to not end up in the vicious circle of bad thoughts. I started swimming and reading as much as possible about depression therapies and systems to fight back.

It's so hard because almost every day when I wake up I'd rather hid myself under the blanket than go to work and dealing with people but I trying as hard as I can to put one foot ahead of the other and go on.

I know at this point this is more about depression than HIV and I know I'm much luckier than a lot of people around here. But unfortunately that's the true nature of depression: to see only the dark side and feel miserable for yourself.

So, I'm sorry if anyone feels offended by my attitude and ask your pardon.

Thank you again
Dx Feb. 2018, CD 320, %14

- Atripla Feb/18 -->
- Complera (generic) 2019 -->
- Dovato (generic) 2021 -->

Online Jim Allen

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Re: Thailand
« Reply #20 on: May 27, 2017, 02:28:21 pm »
Glad to hear you nearly have the virus supressed so quickly. Excellent results, keep taking your meds I am sure it will be UD soon.

Great to hear about the swimming as well. Fantastic sport.

Its a head spinning moment for some people when they are diagnosed. Reality is life goes on and I do hope you can work on the metal aspect that is affecting you , the depression. I don't believe people resolve this alone and there is no need to suffer in silence as you are not the first and will certainly not be the last person to suffer from this. Do know it gets better if worked on, focused on for example in therapy and some instances combination of medication but do try to seek help in doing do and keep engaging with your doctor's. I know that is not easy but self diagnosis and treatment is also not the way to go.

Take it easy.

Jim

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Offline Ptrk3

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Re: Thailand
« Reply #21 on: May 27, 2017, 03:39:32 pm »
Your results are quite good, actually, since your CD4 numbers and percentage is strong and your Viral Load (VL) would have been considered "undetectable" not that long ago.  In any case, your VL has fallen drastically and will likely be "undetectable" with your next labs.

You are doing quite well.  Congratulations on your ongoing journey to healthy living and a long life!

Now, just focus a bit on dealing with your depression.  As Jim correctly points out, there are many ways to successfully deal with this common affliction to the HIV positive.  It may take some time and work, but it does get better, truly.

Best wishes to you.
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Offline terrymoore

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Re: Thailand
« Reply #22 on: May 28, 2017, 11:21:09 am »
Hi,
I know you have already heard it, but i will say it again. Your numbers are great! You are showing progress and the meds are working. Your CD4 is well into the "normal zone" and your VL has reduced significantly.
Regarding your depression, have you spoke to your HIV doc re this? As mentioned, Atripla is great, but not for everyone. Depression is one of the reasons to switch from Atripla. This of course must first be checked with your doctor.
Keep your head up bro - things are going in the right direction.

Offline alpanz

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Re: Thailand
« Reply #23 on: June 01, 2017, 05:28:22 pm »
Im on Atripla for over 2 years.
Im on therapy as Im not felling very well (depresion, not able to find my way, loosing interest in everything including sex).
I started a couple of weeks ago on depression pills... we'll see how this goes.

I read your thoughts on Atripla... and I will talk about this with my doctor, maybe this is causing my depression. Thanks for the great help

Offline terrymoore

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Re: Thailand
« Reply #24 on: June 01, 2017, 10:56:41 pm »
@alpanz - i am not doctor, so i will only give my OPINION based on what i read and my experience. It seems that Atripla is a wonder-drug and has helped many many many people. It is very convenient - one pill a day with no food needed etc. Unfortunately, SOME people react bad. I am one of those people. As soon as i started i became "dull", i was moody, i could not make the simplest decisions ("what will i do today?") and i was very "foggy". This all stopped a day or 2 after switching to Complera.
I suggest you speak with your doctor (and maybe another) regarding this. BTW there is a full separate section regarding this topic in this forum here https://forums.poz.com/index.php?topic=47901.0 . Good luck!

Offline Mindless

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Re: Thailand
« Reply #25 on: June 03, 2017, 11:27:53 am »
Im on Atripla for over 2 years.
Im on therapy as Im not felling very well (depresion, not able to find my way, loosing interest in everything including sex).
I started a couple of weeks ago on depression pills... we'll see how this goes.

I read your thoughts on Atripla... and I will talk about this with my doctor, maybe this is causing my depression. Thanks for the great help

Hi alpanz,

to be fair my depression pre-existed the HIV/Atripla stuff. Anyways yes, I see there is quite a debate about its possible adverse effects on mood/mental balance. In my case it's almost impossible for me, at least for now, to tell how much of the depression flare is due to Atripla, how much to the recent diagnosis and how much was just latent.

Anyways, luckily there are alternatives now: me too I'm thinking to try and change medication in the future too see if the situation improves. Thanks to Terrymoore, Expat1 and others above I came to know about Complera, which doesn't contain Efavirenz and is available here where I live, so I'm thinking to see another doc (my present one for some reason wants me to stick to Atripla) to have a second advice and possibly switch medication.

All the best

Dx Feb. 2018, CD 320, %14

- Atripla Feb/18 -->
- Complera (generic) 2019 -->
- Dovato (generic) 2021 -->

Offline terrymoore

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Re: Thailand
« Reply #26 on: June 03, 2017, 01:33:57 pm »
@Mindless please make sure to speak with a doctor and consult with him/her. No one on this site is authorized to suggest any med change - i hope you did not get that from what i wrote. All i said is what happened to me and that you should check with your doc and mention to him your depression. Just making sure you do not self-diagnose  ;)
Good luck

Offline Mindless

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Re: Thailand
« Reply #27 on: June 03, 2017, 10:39:29 pm »
@Mindless please make sure to speak with a doctor and consult with him/her. No one on this site is authorized to suggest any med change - i hope you did not get that from what i wrote. All i said is what happened to me and that you should check with your doc and mention to him your depression. Just making sure you do not self-diagnose  ;)
Good luck

Hi Terrry,


don't worry, I get what you mean. I'm still on Atripla and as I wrote I'm not sure at all that the depression flare I'm experiencing is due to that. But now I know that's one of the possibilities. When I told my doc about the depression he just told me there's no viable alternative to Atripla (he may have some reasons I'm not aware of though) and to talk to a psychiatrist to adjust the depression meds dosage.

This was a few months ago. Now the depression is still there but I'm trying to work on it. The other physical side effects seem to have faded away mostly and the Atripla seems to be working well on the HIV. The main thing I'm worried about now is my mental health and the other possible long term side effects of the meds.

I'm planning to see some other hiv doc (possibly the one you suggested some time ago) to have a second advice on if and when switching medication.

Thanks
Dx Feb. 2018, CD 320, %14

- Atripla Feb/18 -->
- Complera (generic) 2019 -->
- Dovato (generic) 2021 -->

Offline terrymoore

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Re: Thailand
« Reply #28 on: June 03, 2017, 11:53:47 pm »
Quote
I'm planning to see some other hiv doc (possibly the one you suggested some time ago) to have a second advice on if and when switching medication.
Dr. Anuwat at Bumrungrad is a great doctor and a great guy! HE will surely present to you ALL the options and his professional opinion. I am wondering, is it possible that you have a resistance to certain meds? Has this ever been mentioned? It is strange that your doc does not present the alternatives, Both my first doc (at Samitevej) and Anuwat mentioned this from the onset of treatment.

Offline Mindless

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Re: Thailand
« Reply #29 on: June 04, 2017, 01:03:24 am »
Dr. Anuwat at Bumrungrad is a great doctor and a great guy! HE will surely present to you ALL the options and his professional opinion. I am wondering, is it possible that you have a resistance to certain meds? Has this ever been mentioned? It is strange that your doc does not present the alternatives, Both my first doc (at Samitevej) and Anuwat mentioned this from the onset of treatment.

Hi Terry,

actually I have no idea about resistance issues. When I started treatment I didn't even knew what "resistance" meant and was just recommended to go on Atripla right away. One thing I read though is that to get on Complera (or better the generic 2 pills version) you should start treatment with a VL <100k and mine was 175k when I first tested. I have no idea if that played a role in the choice as well, my doc is actually a decent guy but seems to have the "old style" approach with patients (or maybe he was just trying to keep my anxiety at bay by not sharing too much potentially worrying infos, I have no idea).

Anyways, I'm really thinking to get an appointment this week with Dr Anuwat to hear what he thinks about that (under alias of course  ;))
Dx Feb. 2018, CD 320, %14

- Atripla Feb/18 -->
- Complera (generic) 2019 -->
- Dovato (generic) 2021 -->

Offline daveR

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Re: Thailand
« Reply #30 on: June 04, 2017, 01:12:52 am »
Hi Terry,

actually I have no idea about resistance issues. When I started treatment I didn't even knew what "resistance" meant and was just recommended to go on Atripla right away. One thing I read though is that to get on Complera (or better the generic 2 pills version) you should start treatment with a VL <100k and mine was 175k when I first tested. I have no idea if that played a role in the choice as well, my doc is actually a decent guy but seems to have the "old style" approach with patients (or maybe he was just trying to keep my anxiety at bay by not sharing too much potentially worrying infos, I have no idea).

Anyways, I'm really thinking to get an appointment this week with Dr Anuwat to hear what he thinks about that (under alias of course  ;))

I think they like you to be undetectable for atleast 6 months before they make the switch from Atripla to Complera. I take the two pill version of Complera and other than the occasional insomnia I have no problems. Certainly no depression.

Offline terrymoore

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Re: Thailand
« Reply #31 on: June 04, 2017, 01:17:59 am »
note that there are other options as well. Stribild, Tivicay and many others. Anuwat will usually try to keep it as simple/convenient as possible and at the lowest cost. He is a supporter of generics too.
BTW - perhaps that is why they keep you on Atripla - too first reduce you to UD for 6 months. I really don`t know. That is why you must consult with a doctor.

Offline Mindless

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Re: Thailand
« Reply #32 on: June 04, 2017, 01:24:54 am »
Thank you guys,

your valuable input is much appreciated by a "newbie" like I am.

M
Dx Feb. 2018, CD 320, %14

- Atripla Feb/18 -->
- Complera (generic) 2019 -->
- Dovato (generic) 2021 -->

Offline playboix

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Re: Thailand
« Reply #33 on: June 05, 2017, 08:46:47 am »
Hi, guys, my name is Ben and I moved to Thailand 6 months ago.

First of all, thank you for starting the thread Mindless and stay strong yeah!

Im piggybacking this thread to ask my own questions.

so my company will give me insurance, should I lie about my HIV status?

what are the consequences, also that insurance is shit so I'm planning to get my own insurance too.
I am funding my own medical and its no problem for me. However, when I get sick it cost a lot of money. for example, i has an abscess on my bum and it needed surgery, that's like good 50k kinda money.

For say if I get insurance should I declare or just lie? if I do get one any recommendations?  any help? thanks!

Offline terrymoore

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Re: Thailand
« Reply #34 on: June 05, 2017, 11:35:11 am »
Hi Playboix, Please PM me, i covered this with others in the past.
Bottom line, i would NOT inform them. If you can pay for your HIV treatment, you can do it under an Alias. The only person that knows the both names is my ID and he helps me out. Again, if you PM me ill explain.

Offline virgo313

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Re: Thailand
« Reply #35 on: June 05, 2017, 01:10:45 pm »
Hi Terry,
Don't think playboix can PM u until he/she is "promoted to rank of Sargent'.
3 public post before PM. Thanks
RVD Nov 2015. VL --> Log 5.32 HAART on 23/11/15
TDF+FTC+EFV / Chemo KS - 25/11/15 - 20/01/16.
CD4 - 4 (3/11/15) / VL - 225,000

Offline terrymoore

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Re: Thailand
« Reply #36 on: June 05, 2017, 10:57:21 pm »
@virgo oh! thanks!
@playboix - i too worry about my insurance/employer finding out. I therefore do NOT reveal my status. I go to the hospital under a different name (when i register i say i forgot my ID and will bring it next time - easy) and then pay cash.
i DID tell my doctor and explained why. I keep the insurance for major things - heart attack, cancer, car accident etc, - and anything HIV related i pay cash and want off my record. I let him know this and my real name so that he can be aware of the entire medical history. May i ask, were you Dx`d at an anonymous clinic or at a known hospital? for me it was at a hospital so for sure they have it on record. At the time i asked them to remove it from my record and they said they did and opened up an anonymous record, but i have no way of actually verifying that. In any case i have renewed insurance twice and now issues. i hope this helps.

Offline Expat1

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Re: Thailand
« Reply #37 on: June 10, 2017, 06:09:31 pm »
My suggestion is to keep the insurance for the occasional visit to the ER for stitches. ETC.  And buy your HIV meds from a different hospital.  (or Red Cross Clinic).

For mindless, yes the reason that you were started with Atripla and Not Edurant is because of you starting Viral Load.   My doctor wanted me to be on Atripla for 1 year, before the switch (i m bad and only lasted 11 months) but my starting VL was 42000.

Some doctors will not consider switching anyone who was ever over VL100000 for a switch to Endurant, others will.  No real quidelines for this switch.  Never been studied.  There are other options however.  Like Stribild or Recovir EM plus Tivicay. 

The EFV in the combo table will cause the RPV  in Edurant to be metabolized more quickly.  This means that the RPV at switch for the first few weeks will be lower.  The EFV is still around but at lesser degrees.

This is one reason you must be undetectable.  There is the potential that resistance could form to any of the drugs if the values fall too low.  Especially the case in someone who starts above VL100000.

So just tough it out until  the doctor is confident in making a switch.

Also Edurant has some CNS issues also.  Including insomnia and depression.  Though less than EFV.

Otherwise the CD numbers look really great and the VL has gone down significantly as well. 

Offline Mindless

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Re: Thailand
« Reply #38 on: June 14, 2017, 12:15:33 am »
Hi Expat,

thank you for all your advices. Yes, my VL was 175,000 when diagnosed and me too I read somewhere that Complera (or its generic version) are not recommended above 100,000. My last VL count was 333 1 month ago and 3 after starting Atripla: so it looks like the med is working thought I'm not yet UD.

Also in my case the depression pre-existed the hiv DX and ART starting. Hence, it's not at all easy to tell how much of that is pre-existing and how much may be a side effect.

Thank you for your interest, much appreciated.
Dx Feb. 2018, CD 320, %14

- Atripla Feb/18 -->
- Complera (generic) 2019 -->
- Dovato (generic) 2021 -->

Offline Mindless

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Re: Thailand
« Reply #39 on: June 14, 2017, 12:27:49 am »
As for the insurance,

I have one paid by my employer and I'm very worried the Hospital passed my DX info to the Insurance company (and therefore to my employer): the more the renewal date approaches the more I'm scared. Soon after the DX I started paying all my meds and dr. visits in cash out of my pocket but still somewhere there's a record about me.
Dx Feb. 2018, CD 320, %14

- Atripla Feb/18 -->
- Complera (generic) 2019 -->
- Dovato (generic) 2021 -->

Offline Mindless

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Re: Thailand
« Reply #40 on: June 14, 2017, 01:01:32 am »
Last week I eventually took the advice from Terry and went to meet dr Anuwat at Bumrundgrad hospital. I was so worried to explain my history and he was in a hurry with a queue of patients waiting and pushing... that when I got out I realized I forgot to tell him about 1 of the reasons I was there (my bad).

Anyways, I asked him about possible alternatives to Atripla since I'm worried that can affect my depression. I got following advice that basically are a repetition of what you more experienced guys already suggested:

1) As everybody knows the "risky" component of Atripla for depression is Efavirenz (EFV)
2) There may be basically 3 alternatives to Atripla each of them implies replacing the EFV with another drug in the same "class":

Option 1: Complera (generic version in 2 pills)
Option 2: Stribild
Option 3: Triumeq

Now, each of these come with different problems in my specific case.

Option 1: there's a possible dangerous interaction with 1 of the depression drugs I take (Seroquel). Besides, it would not be recommended in someone with VL >100,000 and it must be taken with a meal (Atripla is not)
Option 2: possible interactions with practically all the depression meds I'm taking (Wellbutrin, Zoloft, Seroquel)
Option 3: no interactions, the problem in this case would be the cost, around 12,000 bath/month (about 320 $). Besides, I'm not even sure it's already available in Thailand.

I got out pretty depressed from the appointment: seems like I have no choices right now but keeping the Atripla.

Dx Feb. 2018, CD 320, %14

- Atripla Feb/18 -->
- Complera (generic) 2019 -->
- Dovato (generic) 2021 -->

Offline Mindless

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Re: Thailand
« Reply #41 on: June 14, 2017, 01:33:14 am »
The day after

After the appointment with Anuwat I decided I have to do something about my depression meds at all costs. I know I shouldn't make decisions about meds without talking to a shrink but I've been taking them for too many years now (more than 10 for what I can remember, maybe more).

Besides, I'm getting more and more worried for the "toxic load" on my liver: since 1 month at least I'm experiencing strange effects on my feces. Clearer color, different consistency, there's something wrong...

I know, I know should talk to a psychiatrist and so on but I've already tried a couple: here (Thailand) they don't even know about interactions with hiv meds. Anyways, I see one once a month at least to help me make the point of my situation. Not that I get great medical insight but I keep him as a sort of "mentor".

I decided I want to try to withdraw at least 1 of the depression meds gradually (Seroquel): if I can get rid at least of that I may have the option to switch from Atripla to Complera in, let's say, 5 or 6 months from now and see if that helps with the side effects or not.
If I stick to all the antidepressant I take now, I'll never have the chance to try.

I decided I'll go back to meet dr. Anuwat next week and talk to him about my plan and see what he thinks about it.

Sorry to share all this stuff with you but I'm really sick and tired and I don't know who else to talk to about all this stuff.





Dx Feb. 2018, CD 320, %14

- Atripla Feb/18 -->
- Complera (generic) 2019 -->
- Dovato (generic) 2021 -->

Offline daveR

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Re: Thailand
« Reply #42 on: June 14, 2017, 05:14:44 am »
Hang in there Mindless. Easy to say I know but much harder to do. I had issues myself several years ago after an opetation and still do every now and then. Anxiety more than depression. I used self help books and books on Buddism. They actually helped a lot and with nothing else about in Thailand may be your best option.

All the best.

Offline Mindless

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Re: Thailand
« Reply #43 on: June 14, 2017, 10:38:16 am »
Hang in there Mindless. Easy to say I know but much harder to do. I had issues myself several years ago after an opetation and still do every now and then. Anxiety more than depression. I used self help books and books on Buddism. They actually helped a lot and with nothing else about in Thailand may be your best option.

All the best.

Thank you Dave,


from the way you speak I can tell you've been through some really "bad time" and I really appreciate you took the time to drop a couple of lines to support me: in some way this make me feel I'm not alone and there are some great guys out there (sometimes people can be so bad on each other).
Dx Feb. 2018, CD 320, %14

- Atripla Feb/18 -->
- Complera (generic) 2019 -->
- Dovato (generic) 2021 -->

Offline terrymoore

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Re: Thailand
« Reply #44 on: June 14, 2017, 02:08:40 pm »
Quote
I decided I'll go back to meet dr. Anuwat next week and talk to him about my plan and see what he thinks about it.

I am glad you have decided to go back. This time write down all your questions ahead of time and tell him you have a bunch of questions and to please bear with you - be a bit pushy if necessary. I know he can sometimes be a bit "absent minded"ish and also a bit jumpy and seems he has no time, but, you pay for the visit and i am sure he will be happy to answer. It is also important to write down your questions so that you don`t forget anything and then need to come back again!  ;D
In any case, I do not think Option 3 is in Thailand yet and yes, you are correct, that is quite expensive compared to the alternatives.
Regarding a good psych doc, i suggest you ask Dr. Anuwat to suggest someone that you can trust - someone experienced with POZ people. I once had a skin issue and he referred me to someone "in the know" and ho also went along with my "alias" game to help me out. He called the guy, told him my status, what i am on, his opinion and when i git there the guy was prepared and understood the context of the visit.
Regarding stopping your meds on your own - sounds like a throw of the dice to me. i would speak to a doc.
In any case, good luck and i hope your next appointment goes well! Take care!

Offline terrymoore

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Re: Thailand
« Reply #45 on: June 14, 2017, 02:30:54 pm »
One more note, i read that Triumeq WIL be in Thailand in Sept. Price unknown.
Follow this link/thread for updates http://www.adamslove.org/en-agallery.php?mid=124

cheers!

Offline Mindless

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Re: Thailand
« Reply #46 on: June 15, 2017, 10:04:13 am »
One more note, i read that Triumeq WIL be in Thailand in Sept. Price unknown.
Follow this link/thread for updates http://www.adamslove.org/en-agallery.php?mid=124

cheers!

Hi Terry,

actually I guess Anuwat referred to the combination of Kivexa (Abacavir+ Lamivudine) and Tivicay. In fact from your prompt link I this last is now available at the Red Cross. Combined price of the 2 pills: 12,600 bath per 30 pills (about 370$)  :'(
Dx Feb. 2018, CD 320, %14

- Atripla Feb/18 -->
- Complera (generic) 2019 -->
- Dovato (generic) 2021 -->

Offline Expat1

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Re: Thailand
« Reply #47 on: June 17, 2017, 02:41:19 pm »
There is one other option.  You could take Recovir EM  (generic Truvada) and instead of the 600mg dose of EVF found in Atripla, take 2x200mg of EVF.  So 3 pills once daily. By Boyfriend does this.  Not sure how frequently this is used in Thailand.  He sees Dr. Phillip in Pattaya. 

This combo has been evaluated in clinical studies and been found as effective as the 600mg dose. 

Efficacy and safety of efavirenz 400 mg daily versus 600 mg daily: 96-week data from the randomised, double-blind, placebo-controlled, non-inferiority ENCORE1 study

http://www.sciencedirect.com/science/article/pii/S014067361362187X

http://www.sciencedirect.com/science/article/pii/S1473309915700605

Offline Expat1

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Re: Thailand
« Reply #48 on: June 17, 2017, 02:42:54 pm »
First-line ART - ENCORE1 Study - ARV-Trials
www.arv-trials.com/first_line/eng/comp_NNRTI-vs-NNRTI/ENCORE.asp
A reduced dose of 400 mg EFV QD is non-inferior to the standard dose of 600 mg QD, when combined with TDF/FTC over 96 weeks in ART-naive adults with ...

Offline Mindless

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Re: Thailand
« Reply #49 on: June 18, 2017, 12:14:40 am »
All valuable info Expat1! Thank you

I already heard about that from some other guy and I'll keep it in mind as a further option to discuss with the Doc.
Dx Feb. 2018, CD 320, %14

- Atripla Feb/18 -->
- Complera (generic) 2019 -->
- Dovato (generic) 2021 -->

 


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