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Main Forums => I Just Tested Poz => Topic started by: venom_X on August 12, 2019, 03:41:22 pm

Title: venom_X - Introduction thread
Post by: venom_X on August 12, 2019, 03:41:22 pm
Hi

I just test positive a couple of months ago and I'm not sure what the route of transmission is. I can only connect it to a medical procedure done outside U.S. that fits into the time frame of potential transmission

Here's a brief summary:

Day ~ -60: Forth generation Ag/Ab test negative during annual physical in U.S.

Day 0: Did a minor out-patient surgical procedure at a clinic outside of U.S.

Day 14: Onset of acute symptoms: fevers starting at 100.4f going all the way to 103.5

Day 15: Since I was on this forum before seeking prevention strategies, I was aware of the acute symptoms, when the fever didn't go away after repeated Tylenol dosage, I became concerned. Tested with Alere hiv combo test, both Ag and Ab negative

Day 16: Fever is not getting better, extremely worried, observed oral thrush, ARS rash starts to appear on face and upper body. Went to hospital ER, requested RNA and 4th gen test, started ART preemptively, 2 weeks post infection

Day 19: HIV RNA came back positive, 4th gen Ag came back positive, 3rd gen Ab negative, continue ART

Day 24 (5 days post start of ART): First test of quantitative viral load and CD4. VL: 330k, CD4 400 (33%), CD8 460, CD4/CD8 ratio: 0.9; total white count: 4500, Neutrophils: 2300 (near the low normal range)

Week 4.5 (2.5 week post start of ART): VL: 300, CD4: 500 (30%), CD8: 690, ratio: 0.7, white count: 6600, Neutrophils: 4500

Week 7.5 (5.5 week post start of ART): VL: 30,  CD4: 590 (28%), CD8: 920, ratio: 0.6, white count: 4500, Neutrophils: 2000 (near the low normal range)

Have a couple of questions:

(1) Why are the CD4 percentage keeping on dropping even with effective viral replication control

(2) Why are the CD8 continuously expending and thus the CD4/CD8 ratio is dropping

(3) What to take on the up and down of the total white count and Neutrophils even on treatment, with the last VL being 30 and still Neutrophil counts dropped significantly since last measurement

Overall, does the combined expended CD8 and dropping CD4 percentage and CD4/CD8 ratio, and Neutrophils count indicate problems with immune reconstitution while on treatment? 

Thanks so much for your insight!
Title: venom_X - Introduction thread
Post by: virgo313 on August 12, 2019, 04:39:40 pm
Hello Venom,

Your numbers are good. How are you feeling now after dx and on meds?
Title: Re: venom_X - Introduction thread
Post by: Jim Allen on August 12, 2019, 05:07:19 pm
Hiya

Sorry to hear about the reactive results. So you tested negative 60 days before a procedure meaning 150 days before the procedure you did not have HIV.

I don't understand though why you are running nearly bi-weekly CD4/CD8 tests? What's the goal with that? If I ran a CD4/CD8 test over any person HIV positive it would vary strongly, that's normal and your CD4 count is within a normal range the CD8 slightly out.  As for the meds & VL  you have only just started to suppress the virus, give your body time.

What ART meds have you started taking and, have you set up an appointment with an ID doctor?

Best, Jim
Title: Re: venom_X - Introduction thread
Post by: venom_X on August 12, 2019, 06:14:22 pm
Hi virgo I知 doing OK now. No other side effect or symptoms so far other than low fevers every afternoon that rises to 99.5. Emotionally still asking myself why me how it all happened. Incredulous as to how I can get infected this way.


Hi Jim thanks for your reply. I知 worried about the rising CD8 count and percentage . I read that it should slowly decrease with treatment and higher number indicates worse outcomes. Thus was curious if anyone else has seen such trend during their treatment.

I知 in a clinical study evaluating ART impact initiated during acute infection thus the frequent labs. I知 on Biktarvy and has tolerated it well.

Title: Re: venom_X - Introduction thread
Post by: daveR on August 12, 2019, 09:19:18 pm
I use to be concerned about my CD8 count and CD4/CD8 ratio. My Doctor doesn't even check that number, I use to go to a separate clinic and get it done. CD8 count always high and my ratio a bit low. I use to worry about it so I asked my Doctor why she did not check it. She said to her it was unimportant, as long as my CD4 count was good I need not worry as there is nothing they could do to change the ratio. Basically it is what it is. I stopped having mine checked, saved myself some money.
From what I have read, undetectable or not, the body knows there is something in you that should not be there and mounts a defence, it does not know that the meds are controlling the virus, it does what it is supposed to do.
I have to adopt the philosophy of if I can't control it, I can't worry about it.

Dave
Title: Re: venom_X - Introduction thread
Post by: Jim Allen on August 12, 2019, 11:54:09 pm
Hi Jim thanks for your reply. I知 worried about the rising CD8 count and percentage . I read that it should slowly decrease with treatment and higher number indicates worse outcomes. Thus was curious if anyone else has seen such trend during their treatment.

I知 in a clinical study evaluating ART impact initiated during acute infection thus the frequent labs. I知 on Biktarvy and has tolerated it well.

Hiya,

Well, your CD8 count is within the average range, same as your CD4 counts. I.e it's within the average range for HIV negative population.  As for the ratio, the normal range for the CD4:CD8 ratio is between 0.9 and 1.9 so your slightly low not high at the moment on that front.

Here is the thing, you can't change it. ART does not directly change any of this either, ART simply suppresses the virus so it can't unchallenged continue to do measured & unmeasured damage to you, the rest is up to your body/immune system and takes as much time as it takes so there is not much point focusing on these number or stressing about them.

Jim

 
Title: Re: venom_X - Introduction thread
Post by: virgo313 on August 13, 2019, 12:35:29 am
Hi Venom,

My thinking is same as DaveR, that痴 why my reply to you was just to ask how you feel. Trying to 電ivert from the topic of all those 渡umbers/readings.

As other has replied, other readings does not matter. Just the VL and CD4 will do.
Most important is that you are feeling ok. Mind is positive thinking being Poz.
Tks
Title: Re: venom_X - Introduction thread
Post by: venom_X on August 18, 2019, 10:43:46 pm
Thanks all for the replies and support! It has been very helpful, I have been trying to focus on other things in life in the past week and not overtly concerned with the numbers.

One thing that kept on bothering me though, I still have afternoon fevers up to 37.5 (99.5f) almost daily even now 2 months after infection and 1.5 months on treatment. Feeling unusually warm in the afternoon and when checking the temperature indeed it is higher. I don't recall I ever had this problem before being infected. I also lost 15 lbs in 2 months since infected. I'm worried I have other co-morbidity exacerbated by the infection.

Does anyone recall after the acute infection phase with the high fever resolved, was there any lingering low grade fever that dragged on for months?

On other front, I'm feeling better and stronger now compared to a month ago. Blood pressure has been back to the normal range. It was 140/90 during the acute phase and now back to 110/70 as I normally would measure up to. Heart rate is still high, it was over 100 during the acute phase, now down to 75. Before infected, my heart rate was usually low around 60 when seated, apparently the body is still working hard try to recover from the blunt trauma the virus caused during the acute infection. Just hope that it would calm down sometime soon.
Title: Re: venom_X - Introduction thread
Post by: Jim Allen on August 19, 2019, 03:15:41 am
Hiya

Glad to hear you are feeling better. Regarding the afternoon temperature 37.5 is not outside average daytime variance although if you are feeling unwell or it bothers you best see the GP

Jim 
Title: Re: venom_X - Introduction thread
Post by: virgo313 on August 20, 2019, 06:32:51 am
Hi Venom,

Ur VL is undetectable. Ur are gaining back weight. Overall U are felling ok/better.
That is all the signs that you need to monitor.

Looks/seems u are doing lots of other monitoring and I presume at home. Like heartbeat, blood P, temperature.. it not helping ur mind if u start thinking of all these readings. I mean ur mind is already thinking about HIV which is normal and there is no need to add other to ur thoughts.

Not saying that u shd not worry, but for now suggest not to worry too much.
Anytime I fell 砥nwell, go check with ur GP. Don稚 check 途eadings too much. Leave it to the Dr to do them on ur next visit.
Title: Re: venom_X - Introduction thread
Post by: venom_X on September 09, 2019, 08:10:04 pm
Thanks all for the encouragement! Just think to give a quick update on my situation

Just got the lab results at 12 weeks post infection, 10 weeks on treatment with 100% adherence

VL: <30 (a quick question here, I have not seen anyone posted with a PCR assay result that has a quantification limit of 30 copies/ml, not sure why this is the case for my clinic. I was hoping to get the "TND" but anyways it's better than last time)

CD4: 750, (37%), CD8 700, ratio 1.1, so CD4 raised and CD8 dropped moderately within the past 4 weeks (last lab the ratio was 0.6)

Fever seems to have subsided, but still feeling tired/lack of energy most of the time of the day.
Title: Re: venom_X - Introduction thread
Post by: venom_X on November 09, 2019, 02:00:05 pm
I just got the results from the lab done earlier this month

4 months post treatment, 4.5 months post infection

VL<30, CD4 550 (dropped from 750 from 2 months ago, 38%), CD8 450, Ratio 1.2, Elevated liver enzymes

There's a significant drop in total WBC, lymphocytes and CD4, CD8 count since 2 months ago.

CD4 and CD8 both dropped for about 200 counts with percentage remain about the same. There was a monotonic uptrend in CD4 counts in the first 2 months of treatment, but that trend seems to have stopped. CD4 dropped from 750 to 550 in two months :(

Can this be considered normal fluctuations or I should be worried about my bone marrow/thymus functions? I'm also disappointed that the uptrend in CD4 percentage and counts have stopped so early (2 months) into treatment.
Title: Re: venom_X - Introduction thread
Post by: Jim Allen on November 09, 2019, 02:19:42 pm
To quote myself on this very topic

Quote
I've personally dropped over 300 from time to time and had it go back up, no reason at all. Maybe I sneezed  ;)

CD4 counts will vary depending on many factors including what time of day the blood is drawn. In short it could vary 100 points in the same day. It's neither a measurement of overall health or within your control, as long as it's above 200 I would relax and far more important is that your VL remains supressed as it currently is.

Best, Jim

https://www.aidsmap.com/about-hiv/cd4-cell-counts
Title: Re: venom_X - Introduction thread
Post by: venom_X on November 09, 2019, 09:15:51 pm
Thank you Jim for the assuring words. I forgot to mention one result that just came back:

The serum IL-6 test came back with very bad numbers. My serum IL-6 level was extremely high at 8 pg/ml.

I read multiple studies, even for PLWH, the median is only <2 pg/ml and a high IL-6 level correlates with mortality by 139 folds.

This paper describes the average IL-6 levels, with median well below 2 pg/ml (Figure 1, C)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215214/

This paper describes the odds ratio of mortality, with having IL-6 at the 4-Quartile (at 8 pg/ml), will place the risk of being dead within 12 months at a shocking 139 folds as compared to someone with a normal IL-6 level (Table 2)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192038/

Now I read through these studies, I became extremely worried. Is there any additional tests that can be done to ping-point the exact cause of the elevated IL-6?


Title: Re: venom_X - Introduction thread
Post by: Jim Allen on November 09, 2019, 09:37:11 pm
Again, 1 snapshot moment vs trend and not knowing the cause or if there is one.

Not denying inflammation is unhealthy but browsing through the links, my advice, stop digging, or looking for conculsions from studies that are small sample sized, inconclusive or have gaps and might not even apply to you. It will end up driving you around the twist  ;)

See your doctor instead when you retest for the liver values and talk to them about your current issues and also about your fears

When are you seeing them again? This upcoming week right?
Title: Re: venom_X - Introduction thread
Post by: venom_X on November 16, 2019, 10:08:27 pm
Thanks Jim! I just got the test results from this week's blood draw, the liver function returns to normal but urine protein levels elevated :(
Title: Re: venom_X - Introduction thread
Post by: Jim Allen on November 17, 2019, 05:32:47 am
Hiya

Glad to hear the levels are back to within normal values. On the protein levels, elevated how much and what did the doctor say?
Title: Re: venom_X - Introduction thread
Post by: venom_X on December 02, 2019, 06:10:25 pm
The urine protein levels (on a spot urine sample BTW) was 7 mg/dL, kinda borderline high.

The doctor didn't want to do more sensitive tests for the kidney tubular functions that the tenofovir might cause some problems, and want instead to retest in a few months.

He also ordered serum PEP, which showed my gamma-globumin was borderline high (1.7g/L), I read that people with HIV have more incidence of hypergammaglobulinemia and it seems it was the case for me. (My baseline before infection was pretty low in the normal range)