resistance testing. viral load and T-cells

[pozport]

I have declining t-cells of 200 and no viral load.  With no detectable virus is my blood for testing of anti retroviral effectiveness, do I have to wait until I have no t-cells and detectable viral load before I can find out which medication is not working?

[jkinatl2]

I am curious - what makes you believe your meds are not working?

How has the decline been?

How long have you been on meds?

Which meds?

What does your doctor think?

Without a detectable viral load (which uis a great marker for how effective your meds are controlling your virus) it's hard to pin anything on resistance issues. Has your doctor run a resistance test?

For the record, it took me almost five years before my cd4 count rose from 12 to 200, and it's still shy of 240.

Welcome to the forums, by the way

[pozport]

tested Poz in Jan 84, commenced AZT in 1992, T-cells 900, went through many drugs until now on Duranavir, Ritonivir, DDI, 3TC.  Doctor says cannot test for drug resistance as no virus in blood so as I wrote, how does one find out which drugs are no longer working.  Been in DDI for 15 years (been a great anti-retroviral for me) but now doubt that it is still viable.

[buginme2]

Before you started your current medication did you have a resistance test done that you can now reference.  At least you would have a baseline to start with.

Also, the fact that your cd4's have declined during a long period of having an undetectable viral load may have nothing to do with your current medications or resistance.  After all, if your undetectable your meds are working. 

How is your total WBC?  Has it declined, if you have had an overall decline in your WBC then it would also show a decline in cd4's.  A hematologist could identify likely causes. 

What does your doctor say?

[Ann]

Hi Pozport, welcome to the forums.

I have to admit that I gasped when I read you're on one of the "D" drugs - ddl. I didn't think they even used that med in developed countries these days due to its often severe side-effect profile. It is usually the cause of the peripheral neuropathy that so many of our pre-HAART long-term survivors have to live with.

According to our information page on Videx/ddl, it won't work if you have resistance to AZT and if you were on AZT monotherapy in the early days, that may be your problem right there. http://www.aidsmeds.com/archive/Videx_1585.shtml

Is there a reason why your doctor still has you on this dinosaur of an hiv med when there are other, better options available? You could be taking the NRTI portion of your combo in one pill, of which there are two options:

Epzicom/Kivexa, which is abacavir + lamivudine, aka ABC + 3TC.

If you consider Epzicom/Kivexa (different Brand Names are used in different parts of the world), you will need to be tested for abacavir sensitivity first. It's a simple blood test and is discussed on our Epzicom/Kivexa information page.

Truvada, which is tenofovir DF + emtricitabine, aka TDF + FTC.

You can read about these other meds using our Treatments page where all the hiv meds are listed, linking to their individual information pages like the one I linked to above.

BTW, I'm on the same PIs as you, but I take Truvada as the NRTI portion of my combo. It's easy to take with few side-effects.

If I were you, I'd be grilling my doctor as to why he's still prescribing me a "D" drug in this day and age in a developed country. Frankly, I'm shocked.

Good luck. Sending wishes for an increase of CD4s your way!

[leatherman]

Also, the fact that your cd4's have declined during a long period of having an undetectable viral load may have nothing to do with your current medications or resistance.  After all, if your undetectable your meds are working. 

^this
if you're UD then it's not HIV or a med failure that's the problem

what does the doctor have to say about your declining Tcell count??

[eric48]

Hi,
welcome to the forums and congratulations for surviving the virus this long, especially through the period where no or few options where available.

Here, on the forums, there are no docs. only patients willing to share experience and provide guidance on how you could make a move.

they will openly share with you what they (and their friends) have gone through and , hopefully, you may find some good advice.

To be honest, you initial post is a bit cryptic. With this little information you provide about your history, how can you expect that one of the readers may come forward and say "yes, I had the same and this is what I did..."

If the free RNA remains undetectable, then viral replication is out of the picture.

Yet, most people forget one simple thing.

The immune system is build to maintain a certain level of CD4 and CD8 cells.
While the thymus and bone marrow are the nursery for new born CD4 and CD8s, creating and maintaining a complete set of millions and millions (estimation 200 000 000 000 CD4s per person) require an economical and faster population maintenance, i. e. proliferation (homeostatic, mostly), where CD4s will divide in 2, 4, 16, 64... at a very fast rate

Past the age of ca. 50, the thymus is gone (involution). Only proliferation and bone marrow (only a minor provider), can maintain the population.

If this drop in CD4 is sudden and is recovered promptly, then there is nothing to worry about. If this is a slow decline and remains in the 200, a change in combo may do the trick (as par Ann's suggestion), but there can be a number of other reasons for a lower CD4 count

Low CD4+ T-cell counts (CD4 counts) are associated with a variety of conditions, including many viral infections, bacterial infections, parasitic infections, sepsis, tuberculosis, coccidioidomycosis, burns, trauma, intravenous injections of foreign proteins, malnutrition, over-exercising, pregnancy, normal daily variation, psychological stress, and social isolation.

a complete review is provided here:
http://healtoronto.com/irwincd4.html

if willing to see your CD4 count go up at any rate here are a few suggestions:
- have blood drawn in the after noon
- start smoking

That will in no way make your immune defense stronger, but you will feel better about it -;)

Hope this helps

Eric