Looks like treatment failure - $hit!

[SoSadTooBad]

ok, today was a suckful day - sorry to dump this on all of you.  went for my ID appointment today - shitty news all the way around.

VL - 2900  (up from undetectible!!)
CD4 - 414 (down from 453)

ALT - slightly elevated, 53, I think.

I have been 100% adherent to my Atripla regimen, so I was pretty surprised.

Doctor said not to worry - perhaps a lab error, perhaps a blip - (A damn big one, if it is)  and the elevated liver enzymes not unusual on Atripla.

I went and had 10 gallons of blood drawn for a repeat CD4/VL, plus genotype and phenotype, plus Hep test, just in case. 

Anybody have any words of wisdom?  I feel fine physically, but I am as upset as I was when I was diagnosed two years ago.    

[thunter34]

Now, SSTB...you know what I'm gonna say here, don'tcha? 

(1.)  One set of tests does not doomsday make.  It's the trends that are significant.  It's way too early to feel that blue.

(2.)  414 down from 453 is small enough of a drop as to virtually be considered "no change".  Those CD4 counts can bounce + or - 50 each draw.  You know this, right? 

(3.)  414 is still pretty damn good.  There's folks here in single digits.  You are still a good 214 above the AIDS defining line right now, too.  That means you're probably not in any immediate peril of the big deal OI's.

(4.)  VL 2900...while a significant blip from <50, is still a pretty puny number VL wise.  And it may be just that - a blip.

(5.)  Those 10 gallons of blood?  Why... Why, that's just....   Sorry.  I got nothin'.  I hate needles and blood draws suck.

(6.)  Ah!  Here we go!  Quote you:  "I feel physically fine."  That's reason to smile.  And so is this...

(7.)  Even if this does turn out to be the beginning of a trend, you still have lots of options left.

Oh...and   (8.)  We're here for you.

-YPT

 

[pacerintl]

OP I don't see anything that's really upsetting from your numbers and certainly nothing that would indicate anything like treatment failure.  You're VL is high enough that OI's aren't a concern, you have no diarrhea, you're not loosing any weight and you said you feel fine

Just continue to monitor your heath, always take your meds as prescribed even when you might think they are not working...let the DR. MAKE THAT DECISION.

Try to relax until you get the results of the latest labs then you can go over the results with your Dr.

[allopathicholistic]

I hope you dont have resistance. My thoughts are with you.

[Miss Philicia]

Oh... don't be such hand wringers.  Even if it's drug resistance it's not like the 90's where there weren't many alternatives and you had to clutch the pearls as tight as possible.  If it's resistance DON'T FREAK OUT... ain't the end of the world and there's a LOT that will be offered to you, most notably the better drugs that the n00bs here don't get to take (and with less side effects to boots).

Anyway, that's my take on it all... pearls of wisdom and such.

[atxpozguy]

I agree with Philly on this issue. After being poz so long and building up resistance, I am doing okay with Lexiva and Truveda.

[mjmel]

As a followup on these results, has your doctor ordered lab tests to monitor your levels more frequently? Like monthly or every three months?
You won't know if it's a trend or a blimp till the next (or next two) lab results are analyzed. So, you are hindering yourself a bit ....you are right to be concerned about yourself but do not do overstressed at every bump in the road.

Mike

[BT65]

These numbers are just very small variations, and you shouldn't be concerned about them from one round of labs.  Look at the next couple rounds and see where it goes.  And if it is resistance, there are other meds you'll be able to take. 

[David_CA]

OP, you sound like me a couple of months ago!  Well, not quite.  My CD4's are higher, but I've never been undetectable.  Either way, the words 'Treatment Failure' just bring up so many thoughts and images... it's hard to not get upset.  I was also diagnosed just over two years ago and have been 100% adherent to Atripla (although its questioned by my Dr).  I can't even tell that I take it, 'cept that I feel better overall with a lower VL and healthier immune system.  It's a bit scary to think about starting new meds.

Basically, I have no words of wisdom for you; I'll leave it for those who've been around the block a few times with HIV.  I do understand how you feel, though.  Just when we think we have a grip on dealing with HIV something like this comes along.  The way I look at it, there's not a whole hell of a lot we can do about it except to deal with it.  There are a lot of other drugs that we can take, but few are as easy, cheap (one co-pay with insurance), and often side-effect free as Atripla.  I just consider that I have it easy.  If I have to switch, so be it.  What else can I do?  Try not to stress to much over it (Ha!) and do listen to the voices of experience here on the forums.  The meds can make us OK physically.  Being OK mentally is often up to us. 

David

[SoSadTooBad]

Thanks to all of you that responded.  I am waiting (not so patiently) for the labs to come back with genotype and phenotype results, and another VL and CD4 test just to see where things stand.  Looks like the genotype and phenotype tests take a while, so I am not back in front of the doctor until the end of the month.

I know I sound hysterical to the really experienced guys and gals around here - but it's like David_NC said, just when I thought I had things under control, it feels like a new curve ball gets thrown.

Ok - I am going back to work - thanks again to all of you - I appreciate your experience and support. 

SSTB

[BT65]

Why are there a genotype and phenotype being done?  A phenotype is sufficient enough.  And yes, they take a little time to come back.

[SoSadTooBad]

Dr suggested that even though the possibility of resistance was remote, he wanted to interpret the results of both tests to be conclusive.  I had a genotype done when I was diagnosed that showed susceptibility to all drugs that were available as of June 2006.  He said the phenotype provided an additional perspective because it demonstrated in vitro the ability of the virus to replicate (or hopefully not) in the presence of specific drugs.

I just hope the damn thing was a big mistake, but I am seriously doubting it.  VL just seems like too big a jump to be a blip. 

[David_CA]

I had both phenotype and genotype tests prior to starting meds.  The both showed that there should be no resistance.  Nothing about this mess is certain, that's for sure!

David