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Author Topic: About seroconversion and ars  (Read 1019 times)

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Offline Hope4life

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About seroconversion and ars
« on: August 22, 2019, 04:33:44 am »
hey all,
i was writing a review on hiv. but i struck on one thing. Acute retroviral symptoms timeline: I tried to get the answer but i didnt get clear answer. Scientist mentioned that those people who face symptoms, generally get  after 1 to 3 weeks and lasts for 2 weeks. In some diagrams it is illustrated that one week is window period for hiv. But the question is it possible to get symptom before one week? as those symptom might give an indication to go for testing and may reduce the damage of HIV on patients body.
Second question is regarding alcohol. HIV medication do not have any interaction with medicine however patient might get some side effects cos of effect of alcohol on liver and kidney. or alcohol can cause adherence problem. BUT my question is "does alcohol affects viral load of a patient taking medicines regularly?" is there any published study?
thanks

 

Online Jim Allen

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Re: About seroconversion and ars
« Reply #1 on: August 22, 2019, 05:43:27 am »
Hiya,

A review for work, charity or something to be published we can see afterwards?

I ask not to be a dick but out of genuine interest and also because the questions sound like treatment as Prevention fears and I know you have had a few, I hope that is not the case. - Hugs to you.

Quote
is it possible to get symptom before one week? as those symptom might give an indication to go for testing and may reduce the damage of HIV on patients body.

So references will say No, but I get you to want to know why not?
Example:

https://www.thebody.com/article/can-hiv-symptoms-show-up-the-day-after-sex

Quote
if you think you took a risk in the sex you had yesterday, then looking out for symptoms either today or in the coming weeks is a completely unreliable way to infer your HIV status. Many people don't have any symptoms soon after HIV infection or don't notice them. Taking an HIV test is the only way to know.

BTW If you ask me in a twisted sense it would be great if the immune system's reaction causing symptoms to initial HIV infection was somehow unique & all the time, the problem being symptoms are mostly non-specific common to multiple run of mill infections, not noticed by some, missed even by doctors. People should have more access to testing and, be testing regardless of symptoms though, Infrequent testing, fear of testing, not testing post risks or routinely at all are all part of the issue with high late diagnosis rates in my own nation as an example.

The answer, in short, is in studying the Life Cycle of HIV & a bit of biology.  It takes HIV time to infect the cells and be replicated, then there is the time it takes to trigger the adaptive immune response, this last part alone itself takes 4-7 days at least etc etc

Plenty of resources on the HIV Cycle, I included an easy to digest study mentioning the adaptive immune response the response you are interested in to get you started

https://www.ncbi.nlm.nih.gov/books/NBK279396/

Quote
"does alcohol affects viral load of a patient taking medicines regularly?" is there any published study?

Was this a question put to you for the review?

Virological failure. Well, people do drink and, none of the larger or recently published studies has indicated levels of virological failure directly due to the effect of alcohol as long as people were adherent to treatment, that said shift in cells counts, possible VL blips or poor outcome maybe

I tend to look at this one from the practical side, example study; https://www.ncbi.nlm.nih.gov/pubmed/23892243
This would be the biggest, longest I know off the top of my head and most relevant to your question.

Quote
METHODS:
Over a 7-year period, the authors analyzed 2 groups of individuals in the Swiss HIV Cohort Study: (1) ART-naïve individuals remaining off ART and (2) individuals initiating first ART. For individuals initiating first ART, time-dependent Cox proportional hazards models were used to assess the association between alcohol consumption, virological failure, and ART interruption. For both groups, trajectories of log-transformed CD4 cell counts were analyzed using linear mixed models with repeated measures.

RESULTS:
The authors included 2982 individuals initiating first ART and 2085 ART naives. In individuals initiating first ART, 241 (8%) experienced virological failure. Alcohol consumption was not associated with virological failure. ART interruption was noted in 449 (15%) individuals and was more prevalent in severe compared with none/light health risk drinkers [hazard ratio: 2.24, 95% confidence interval: 1.42 to 3.52]. The association remained significant even after adjusting for nonadherence. The authors did not find an association between alcohol consumption and change in CD4 cell count over time in either group.

CONCLUSIONS:
No effect of alcohol consumption on either virological failure or CD4 cell count in both groups of ART-initiating and ART-naive individuals was found. However, severe drinkers were more likely to interrupt ART. Efforts on ART continuation should be especially implemented in individuals reporting high alcohol consumption.

Some studies I believe have shown a faster decline/progression when not on treatment and engaging in heavy alcohol or substance usage. https://www.ncbi.nlm.nih.gov/pubmed/17667330

There are also smaller reviews showing possible alcohol effects, showing moderate alcohol use was not associated with decreased viral suppression questions raised on hazardous levels of drinking and drug usage.     
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704473/

Suppression aside there are studies to indicate people living with HIV get a quicker buzz from alcohol, and slightly more so if they have a detectable VL.

Example

https://link.springer.com/article/10.1007/s10461-015-1053-7
https://www.pharmacytimes.com/resource-centers/hiv/lower-alcohol-tolerance-seen-in-men-with-hiv

Quote
1478 men with HIV and 1170 without it—to determine the average number of drinks it takes to generate a buzz.
 
Of the HIV-infected men, 607 had detectable HIV-RNA viral load (VL), while 871 had suppressed VL. For those with detectable VL, the average number of alcoholic drinks to feel intoxicated was 2.8, compared with 2.9 for those with suppressed VL. This means men with detectable HIV infection had lower alcohol tolerance than men with suppressed infection.

Though not the primary goal, none of those alcohol & effect type studies on PLHIV studies recorded major virological failures in their reviews when someone was adherent to treatment.

On the viral suppression to level below transmission (200 copies) like the partner study, I am sure over the 20 years people were allowed to have a pint during the studies, let me put it like this I did not see any additional dietary restrictions mentioned on the studies or U=U / TaSP conclusions asides from what is already part of peoples treatment regime that should go without saying.

http://i-base.info/htb/32308

Castilla J et al. Effectiveness of highly active antiretroviral therapy in reducing heterosexual transmission of HIV. J Acquir Immune Defic Syndr 40: 96-101, 2005

Vernazza P et al. Bulletin des médecins suisses 89 (5), 30 January 2008


Hope some of this helps get you started.

« Last Edit: August 22, 2019, 06:33:37 am by Jim Allen »
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Offline Hope4life

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Re: About seroconversion and ars
« Reply #2 on: August 22, 2019, 06:57:46 am »
Hello Jim,
Thanks for the detailed answer. No doubt you actually have depth knowledge in the area. Thanks again.
Well the review i  want to write is for my work but acvtually now i feel close to HIV cause hence i decided to write on that. I have areas where i want to write a review, HIV as Taboo, HIV: from its first day to the last. and i was just writing down few points which i may cover in review.

Actually I asked my first question because i found there is a difference of views on the life cycle/stages of HIV. There is an eclipse phase than we have  Fiebeg stages 1 and 2 stages. and than there is window period of detection. All these stages may affect the aftermath of the treatment. hence i thought to write specifically on these stages.
Now coming to my alcohol question: Well I do drink but I am undetectable from last 2 years however somewhere I do feel that this is a major question now a days. Thats why we find many threads on this forum too. Moreover repercussions of alcohol intake should also be reviewed (in separate review or in the same by some mean). so thought to ask it here first.
Once again thanks JIm for providing the date and I will get into it and will share my thoughts with you if thats fine with you . Thanks
   

Online Jim Allen

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Re: About seroconversion and ars
« Reply #3 on: August 22, 2019, 09:37:37 am »
Hiya

Glad the info helped getting you started and I hope your review/write-up goes well.

Well the Fiebig criteria or lab stages are not the same as the (biological) life cycle of HIV infecting a cell and finally the triggering or time for an adaptive immune response and the person perhaps noticing it after that, this takes time and part of the reason resources will say there are no initial symptoms in the first week

My understanding would be Fiebig stage 1 is "HIV present in blood samples, only RNA assay positive" so antibodies not yet at high enough levels for detection, going back to the initial question it will not be answered by Fiebig criteria. It is correct that over the decades info has been added to the cycle but nothing in recent years that would really alter the high-level flow or change the info needed to answer your first question.

As for alcohol well i'm biased to start with, but there is plenty of studies & proof how damaging it is to the human body/mind and more to the point the terrible effects it can have for people living with HIV. I do think it's a bit over studied at this point in the game though, key message seems to be moderation and it will not change your VL if suppressed adherent to treatment.

Oh before I forget one tip i will share, always tailor the content to the audience, i.e understand the level of the audience so if it's people not familiar with HIV you might not want to get too technical or deep into it. I thought these were an "okay" overviews

https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/25/84/hiv-and-drug-and-alcohol-users

https://www.aidsmap.com/about-hiv/alcohol


Best, Jim

« Last Edit: August 22, 2019, 09:47:16 am by Jim Allen »
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Online harleymc

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Re: About seroconversion and ars
« Reply #4 on: August 23, 2019, 07:33:33 pm »
I'm always amused by people looking for 'symptoms of HIV infection'.  If it was so easy there wouldn't be any need for testing. 

My symptoms night sweats a new swollen glands happened about  a year after my positive test results.  I had no symptoms prior to the test, but was advised to by my positive lover.

Offline Hope4life

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Re: About seroconversion and ars
« Reply #5 on: August 24, 2019, 02:33:43 am »
I'm always amused by people looking for 'symptoms of HIV infection'.  If it was so easy there wouldn't be any need for testing. 

My symptoms night sweats a new swollen glands happened about  a year after my positive test results.  I had no symptoms prior to the test, but was advised to by my positive lover.

"a year after your positive test results"  ::) . Sir with due respect those were not ARS. those might be because of other reasons. We are specifically talking about ARS here which by literature happen 1 to 4 weeks after exposure. What i specifically asked is that is there any way that eclipse phase is shortened cos of some reasons.

I found reports that in MSM the eclipse phase can be as low as 4 days. however still there is plenty of reports which highlight other facts. Few are as quoted by @jim too. Though hiv test is the only way to know the positive status of the HIV and we are sure about it. Though it is utmost important to know the timeline when we know about the exposure. 

For example i found many questions on many platforms which are posted out of curiosity that they have been exposed 3 to five days back and on 3rd or fith day they are getting symptoms. so is it possible to get ARS that early. in my understading it is not as it may take atleast 6 days for a antigen to come in blood which may trigger response. so i wanted a view of you all . 
:) Thanks

Online Jim Allen

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Re: About seroconversion and ars
« Reply #6 on: August 24, 2019, 02:49:14 am »
@Hope4life

Quote
i found many questions on many platforms which are posted out of curiosity that they have been exposed 3 to five days back and on 3rd or fith day they are getting symptoms. so is it possible to get ARS that early

Okay the last part I must object, Eclipse phase (Fiebig 1) is hard to be accurate about true but even if let's say for sake of discussion it was 4 days, it's not the trigger for symptoms certainly not within 3 days neither is people asking about symptoms within 3 days proof, in fact, it's a very poor reference given co-incidence, commonality in symptoms and possible prior exposures.  If what people asked or claimed becomes the burden of proof it's a very low bar and we would also in terms of HIV still be scared of sharp objects, pencil sharpeners, health department statements and the cat next door.  ;D

All in all though it's simply not possible to notice initial symptoms that are caused by the antibodies response before there is an adaptive immune response fact until proven otherwise, it simply takes longer and I put to you this is why you can't find peer-reviewed references on symptoms within the initial days and why the opposite is reflected in published reference material .

Don't get me wrong I do hope your writing goes well, truly mean that and do keep us posted but don't claim something is possible based on stories, at least not here  ;)

Hugs. 
 
« Last Edit: August 24, 2019, 03:06:58 am by Jim Allen »
HIV 101 - Everything you need to know
HIV 101
Transmission and Risks:
HIV Transmission and Risks
Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read about HIV prevention here:
HIV prevention
Read about PEP and PrEP here
PEP and PrEP

Offline Hope4life

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Re: About seroconversion and ars
« Reply #7 on: August 24, 2019, 06:25:34 am »
Not at all Jim. I certainly don't have intention to narrate stories about hiv symptoms here and specially in front of you all who are much experience than me in the current topic. As I have mentioned that in my opinion too this can't happen. And I just wanted to know why it cannot? Which was well answered by you in your first comment. So I rest my case here. Yes will write article and share with u in person.
Always thankful to u and this platform... :-)


Online harleymc

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Re: About seroconversion and ars
« Reply #9 on: August 29, 2019, 12:16:17 am »
No kidding chuckles, I was illustrating that 'symptoms' are not anything to do with recent infection and should not be relied on as in indicator of seroconversion.

Offline leatherman

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Re: About seroconversion and ars
« Reply #10 on: August 29, 2019, 07:49:41 am »
I'm always amused by people looking for 'symptoms of HIV infection'.  If it was so easy there wouldn't be any need for testing.
that's one of my complaints with several HIV-related facebook healthcare pages (I'm talking about you "healthline: hiv awareness" even though you have been responsive to my posts). They are constantly posting articles about the symptoms of HIV infection, as if those symptoms are a proper indicator for testing. Too often people don't have any seroconversion symptoms or (and I think this is a big factor) the symptoms are so mild as to not be noticed. Relying on symptoms (which, quite frankly, are as the "symptoms" of a hundred other issues and sometimes not "symptoms" of any illness at all) instead of a risk assessment of activities (unprotected sex, sharing needles, etc) leads to more HIV transmissions by the undiagnosed and late diagnoses for many others.
leatherman (aka mIkIE)


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