Some questions

[BM]

Hello everyone.

I was diagnosed positive at the start of July this year after I became ill with PCP. My stats were CD4 78 (7%), VL 190,483. I wasn't started on meds until a month later (until the PCP cleared up), when my stats were CD4 37 (6%), VL 1,108,190. After a month on Kivexa and Viramune, my CD4 is now 120. I don't know what the percentage and VL are yet. Does this represent an optimal response to this regimen? Is such a gain in CD4 indicative of a good prognosis? I am also taking Dapsone, Omeprazole and Cetirazine, and using Nizoral shampoo.

Thanks for any help,
Brian

[Miss Philicia]

You've tripled your cd4 count in one month, so yeah that's good progress.  I'm not sure how one can say anything is "optimal" though without knowing your viral load response, which is the more important number in evaluating how quickly your HIV medication is working.

[BM]

Thanks for your reply.

My doctor told me that I could dose my Viramune (Nevirapine) by taking one tablet every twelve hours or by taking two tablets every twenty-four hours. I've been using the latter, yet I've read here (and elsewhere) that this is associated with higher rates of virological failure. Do you think it might be worth switching to the other dosing schedule? I'm not due to visit my doctor for another fortnight.

Sorry if anything I ask is obvious: I'm still trying take it all in.

Thanks,
Brian

[Miss Philicia]

BM, it's been around a decade since I was last on viramune so I'll just go by what's written here:

http://www.aidsmeds.com/archive/Viramune_1616.shtml

I see you're in Scotland, but that says the US FDA has not approved that dosing you're referring to, and my conservative side on such issues would make me go with the twice daily route just to be on the safe side.  This NNRTI class is very susceptible to cross resistance, meaning if you screw it up you screw up the entire class.  I'm borderline resistant to this class myself because viral replication was never fully suppressed when I was on it 12 years ago, and consequently when they switched me to Sustiva 3 years later that didn't work either.

[J.R.E.]

My doctor told me that I could dose my Viramune (Nevirapine) by taking one tablet every twelve hours or by taking two tablets every twenty-four hours.

Sorry if anything I ask is obvious: I'm still trying take it all in.

Thanks,
Brian

Hi There,

I've been on Viramune since October of 2003. Somewhere early in 2004, my doctor also suggested that I could take both Viramunes together. I did try that for a while, but I felt that both together was a little intense for me, so I went back to one Viramune every 12 hours. Myself, I like this way better.

I was also taking Dapsone at the same time.  I had a similar situation to yours. I also started out with a low  t-cell count of 16 , percentage around 4% and a 500,000 viral load. Was also on Zithromax from October of 2003 to somewhere I believe around March or April of 2004. I would have to look at my journal, to verify that.

Let us know when you get your Viral load and percentage, Otherwise, you are making improvements. Things will take time. I've been there !! You just hang in there !


Ray

 

[BM]

  Thanks, I'll post my numbers when I get them.

Just out of interest, is there a 'most likely' replacement if my current Kivexa/Viramune combination should fail? Do you think I'd be allowed to go on an Isentress-based regimen, bypassing protease inhibitors?

[J.R.E.]

Thanks, I'll post my numbers when I get them.

Just out of interest, is there a 'most likely' replacement if my current Kivexa/Viramune combination should fail? Do you think I'd be allowed to go on an Isentress-based regimen, bypassing protease inhibitors?

Hello Brian,

I really don't know the answer to that.  When it comes to different mutations and resistance issues, I am really at this point not up on that. 23 years of living with this, and there is a great deal I don't know. I will leave that to the doctor if/when the time comes.  The main thing is getting the viral load to undetectable and to maintain it.

Try not to put the cart before the horse. Your on very good medications. Kivexa, Is the same ( I believe ) as Epzicom , which I am also on( besides the Viramune) pretty much since the beginning.


Hang tough----Ray

[BM]

I just got my test results back. The day I started my meds, my CD4 was 37 (6%), and VL was 1,108,190. After a month, the numbers are CD4 122 (8%), VL 118,484. My doctor says the CD4 gain is great, but I didn't really know how to read her reaction to the viral load decrease; I suspect she thinks it could have been greater.

[J.R.E.]

Hello !,

I think you've made great progress in reducing your Viral load. You went down almost 90% in viral load over the past month ! You've also had a nice increase your t-cell counts, and 2% increase in percentage. Your heading in the right direction.

See this :


http://www.aidsmeds.com/articles/WhenToSwitch_4766.shtml

If your viral load is not lower than 400 after 24 weeks (six months) of starting therapy. An early way to tell if a drug regimen is being effective is to look for a 90% drop in viral load between 2 to 8 weeks after starting therapy. For example, if your viral load starts off at 50,000 and drops to 5,000 after 8 weeks, chances are good that your viral load will be less than 400 after six months of treatment


Ray

[BM]

Hi Ray. I'm certainly very pleased with the results, I'm now also beginning to develop a sense of how treatment will progress. I had reasoned that because the drugs interfere with viral replication and because the "lifespan" of each viral particle is less than a few days, I should get to undetectable quite quickly! Maybe that's how it works on paper!

I have arranged to get my test results when they're ready (instead of waiting a month till my next appointment). The result I posted today is of last month's test, so I should be able to post the results of today's test before a month has passed.

[newt]

Just out of interest, is there a 'most likely' replacement if my current Kivexa/Viramune combination should fail? Do you think I'd be allowed to go on an Isentress-based regimen, bypassing protease inhibitors?

Conservatively, and based on a resistance test, the next logical nad best supported by research choice would be aorganised around a boosted PI.

- matt

[BM]

Latest labs, after two months' treatment:

CD4 89 (6%), VL 90,231

Slightly confusing...