Welcome, Guest. Please login or register.
November 29, 2020, 06:43:26 pm

Login with username, password and session length


Members
Stats
  • Total Posts: 757290
  • Total Topics: 64069
  • Online Today: 342
  • Online Ever: 4912
  • (November 13, 2019, 02:56:14 am)
Users Online
Users: 4
Guests: 248
Total: 252

Welcome


Welcome to the POZ Community Forums, a round-the-clock discussion area for people with HIV/AIDS, their friends/family/caregivers, and others concerned about HIV/AIDS.  Click on the links below to browse our various forums; scroll down for a glance at the most recent posts; or join in the conversation yourself by registering on the left side of this page.

Privacy Warning:  Please realize that these forums are open to all, and are fully searchable via Google and other search engines. If you are HIV positive and disclose this in our forums, then it is almost the same thing as telling the whole world (or at least the World Wide Web). If this concerns you, then do not use a username or avatar that are self-identifying in any way. We do not allow the deletion of anything you post in these forums, so think before you post.

  • The information shared in these forums, by moderators and members, is designed to complement, not replace, the relationship between an individual and his/her own physician.

  • All members of these forums are, by default, not considered to be licensed medical providers. If otherwise, users must clearly define themselves as such.

  • Forums members must behave at all times with respect and honesty. Posting guidelines, including time-out and banning policies, have been established by the moderators of these forums. Click here for “Do I Have HIV?” posting guidelines. Click here for posting guidelines pertaining to all other POZ community forums.

  • We ask all forums members to provide references for health/medical/scientific information they provide, when it is not a personal experience being discussed. Please provide hyperlinks with full URLs or full citations of published works not available via the Internet. Additionally, all forums members must post information which are true and correct to their knowledge.

  • Product advertisement—including links; banners; editorial content; and clinical trial, study or survey participation—is strictly prohibited by forums members unless permission has been secured from POZ.

To change forums navigation language settings, click here (members only), Register now

Para cambiar sus preferencias de los foros en español, haz clic aquí (sólo miembros), Regístrate ahora

Finished Reading This? You can collapse this or any other box on this page by clicking the symbol in each box.

Author Topic: suggestions needed - urgent  (Read 1735 times)

0 Members and 1 Guest are viewing this topic.

Offline iamindie

  • Member
  • Posts: 12
suggestions needed - urgent
« on: July 30, 2020, 07:50:41 am »
i am 57
last Sept i diagnosed HIV+
and i started taking Zidolam (Lamivudine (150mg) + Zidovudine (300mg)) two times a day after meal and Naivex (Dolutegravir 50mg)one time daily at night after meal


my HIV viral load is 70
%CD3+/CD45+      75.3
Absolute CD3+     812
%CD3+/CD4+      34.6
Absolute CD4+     373

But the medicine is affecting my liver
my SGPT is 148.20
ang SGOT is 97.40

Please suggest what should i do

Offline Expat1

  • Member
  • Posts: 361
Re: suggestions needed - urgent
« Reply #1 on: July 31, 2020, 05:07:55 am »
It is probably the AZT.

Dr could switch it out with Tenofovir.

Dolutegravir can be given as a 2 drug combo with just the lamivudine.

I am not a doctor.  Consult you doctor on those options.

How far above normal are your liver tests. Ok.  About 2.5X and 4.5x.

Not uncommon when starting.  It happened to me when I started ART.  Dr just kept real close tabs on it for a month and it returned to Normal levels.  He also checked for Hep A, B, and C.  Asked about alcohol consumption.l

I really can't drink while on ART. 
« Last Edit: July 31, 2020, 05:14:13 am by Expat1 »

Offline joemutt

  • Member
  • Posts: 1,140
Re: suggestions needed - urgent
« Reply #2 on: July 31, 2020, 06:57:38 am »
I suggest you talk to a doctor.

Offline iamindie

  • Member
  • Posts: 12
Re: suggestions needed - urgent
« Reply #3 on: August 01, 2020, 12:16:52 am »
It is probably the AZT.

Dr could switch it out with Tenofovir.

Dolutegravir can be given as a 2 drug combo with just the lamivudine.

I am not a doctor.  Consult you doctor on those options.

How far above normal are your liver tests. Ok.  About 2.5X and 4.5x.

Not uncommon when starting.  It happened to me when I started ART.  Dr just kept real close tabs on it for a month and it returned to Normal levels.  He also checked for Hep A, B, and C.  Asked about alcohol consumption.l

I really can't drink while on ART. 

Hi expat
Thanx for reply
I don't drink
I started ART last September (2019)
And Dr checked my hepatitis A B & C, they are ok
After starting ART from Sept 2019my liver function was ok untill April 2020. Then my sgpt and sgot started increasing. But Dr stick to medicine he is giving. Now my SGPT is about 3.5 times normal and SGOT is about 2.5 times normal
Due to civic I couldn't meet Dr. Next week I will try to consult him.

Offline Expat1

  • Member
  • Posts: 361
Re: suggestions needed - urgent
« Reply #4 on: August 02, 2020, 12:37:06 am »
My liver also had its 3x normal phase at about 6 months.

Good luck.  Your doctor seems on top of this. 

Offline iamindie

  • Member
  • Posts: 12
Re: suggestions needed - urgent
« Reply #5 on: September 30, 2020, 05:36:41 am »
i was diagnosed poz last year in sept,2019
and my VL was 2250 and CD4 was 384
Doc advised me to take Dolutegravir 50 mg at night
and lamivudine+zidovudine (150+300) two times a day
in may,2020 this year my VL was 70, CD4 was 373 and cd4/cd8 ratio was 0.90
but i got my ALT(SGPT) and AST(SGOT) raised about 4 times normal values
so Doc switched lamivudine+zidovudine (150+300) to Darunavir+ritonavir(800+100) in August,2020
today my VL is 66, CD4 is 859 and CD4/CD8 ratio is 0.99

I dont understand,
why my VL is still about 70, not less than 20 after taking ART for a year
My CD4/CD8 ratio is less than 1, is it too bad??
Side effects of Darunavir+ritonavir(800+100)???, is it kidney friendly
is Dolutegravir kidney friendly??

please anyone
thanks in advance

Offline Jim Allen

  • Administrator
  • Member
  • Posts: 16,306
  • Twitter @JimAllenDublin
    • HIV Lessons
Re: suggestions needed - urgent
« Reply #6 on: September 30, 2020, 08:00:54 am »
Hiya,

Well the good thing is anything under 200 is considered UD in terms of prevention (transmission). So you can't sexually pass it on. https://forums.poz.com/index.php?topic=71848.0

Treatment wise, generally under 50 copies is fully suppressed/UD. However, there are people who find themselves being in the 50-100 or 100-200 group, there are also some people who experience that it takes longer than a year to get there.

I have included a Q&A with Paul E. Sax, MD on the topic, i find it's good but easy to digest insights on the topic, it might help you. 

What has your own doctor said about the 66 VL?
How are you feeling/doing otherwise?

Best, Jim

https://www.healio.com/news/infectious-disease/20190318/qa-understanding-persistent-lowlevel-viremia-in-people-with-hiv

P.S

Your CD4/CD8 ratio and counts are whatever they are, as far as I know there is nothing you can directly do about them. As such I stopped asking my doctor about these details.

https://i-base.info/qa/5224
https://www.poz.com/basics/hiv-basics/understanding-lab-work-blood-tests
« Last Edit: September 30, 2020, 08:08:37 am by Jim Allen »
HIV 101 - Everything you need to know
HIV 101
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 iamindie

  • Member
  • Posts: 12
Re: suggestions needed - urgent
« Reply #7 on: October 05, 2020, 08:21:10 am »
Thanks Jim
Hiya,

Well the good thing is anything under 200 is considered UD in terms of prevention (transmission). So you can't sexually pass it on. https://forums.poz.com/index.php?topic=71848.0

Treatment wise, generally under 50 copies is fully suppressed/UD. However, there are people who find themselves being in the 50-100 or 100-200 group, there are also some people who experience that it takes longer than a year to get there.

I have included a Q&A with Paul E. Sax, MD on the topic, i find it's good but easy to digest insights on the topic, it might help you. 

What has your own doctor said about the 66 VL?
How are you feeling/doing otherwise?

Best, Jim

https://www.healio.com/news/infectious-disease/20190318/qa-understanding-persistent-lowlevel-viremia-in-people-with-hiv

P.S

Your CD4/CD8 ratio and counts are whatever they are, as far as I know there is nothing you can directly do about them. As such I stopped asking my doctor about these details.

https://i-base.info/qa/5224
https://www.poz.com/basics/hiv-basics/understanding-lab-work-blood-tests

my Doc says my VL @ 66 is ok, good.
i just read all the articles and  Paul E. Sax, MD interview.
got to know about VL
thanks again.


Offline iamindie

  • Member
  • Posts: 12
Re: suggestions needed - urgent
« Reply #8 on: November 13, 2020, 01:44:13 am »
I was diagnosed poz last year in Sept 2019
My VL was 2250 and CD4 was 384
Doc advised me to take Dolutegravir(DTG) 50 mg at night
and lamivudine(3TC)+zidovudine(AZT) (150+300) two times a day

This year in may,2020after taking medicine for eight months, my VL was 70, CD4 was 373 and cd4/cd8 ratio was 0.90
but I got my ALT(SGPT) and AST(SGOT) raised about 4 times normal values
so Doc switched lamivudine(3TC)+zidovudine(AZT) (150+300) to Darunavir(DRV)+ritonavir(RTV)(800+100) in August,2020

today my VL is 66, CD4 is 859 and CD4/CD8 ratio is 0.99
my ALT(SGPT) and AST(SGOT) values are normal now

But during medication, I started having two symptoms.

In the morning when I wake up my body temp.(in mouth) is 97 F (36.11 Celcius) but when I return from the office it is 99F (37.22C). then again it slowly decreases.

My weight is gone down by 11kg, from 65 kg to 54 kg.

And I started getting edema.

Then I met my Dr again, after a lot of tests he referred me to a nephrologist, as my creatinine level shot up to 1.91. The nephrologist adjusted my hypertension medicine and gave me a diet chart to follow.

I am shocked
Why my creatinine level shot up and I became CKD patient?

My Doc doesnít understand why my weight went down and I developed CKD. He says all the medicine (Darunavir(DRV)+ritonavir(RTV)(800+100)and Dolutegravir(DTG) 50 mg) I am taking are kidney-friendly.

He also doesnít understand why my VL is 66, not less than 20. He then again added lamivudine(3TC)150mg twice daily.

Hence, I am taking Dolutegravir(DTG) 50 mg at night, Darunavir(DRV)+ritonavir(RTV)(800+100) in the morning, and lamivudine(3TC)150mg twice daily.

Can anyone suggest, why my VL is still 66, my weight gone down by 11 kg and I developed CKD. And what should I do? I am in India.
 
thanks in advance.

Offline Jim Allen

  • Administrator
  • Member
  • Posts: 16,306
  • Twitter @JimAllenDublin
    • HIV Lessons
Re: suggestions needed - urgent
« Reply #9 on: November 13, 2020, 07:02:01 am »
Hiya,

Not sure why you are measuring your body temperature, it will fluctuate hour to hour even and 36-37 +- range you report would be perfectly normal. https://www.webmd.com/first-aid/normal-body-temperature#1

Sorry to hear that you are still stressing about the VL, why did the doc add additional HIV meds? I thought they had said it was fine? VL 66 I would not be changing anything.

Quote
my Doc says my VL @ 66 is ok, good.
i just read all the articles and  Paul E. Sax, MD interview.
got to know about VL
thanks again.

Quote
he referred me to a nephrologist, as my creatinine level shot up to 1.91. The nephrologist adjusted my hypertension medicine and gave me a diet chart to follow.

Keep us posted on the adjustment of the meds and diet and how things go. When is the next checkup? What's the diet like?

Best, Jim
« Last Edit: November 13, 2020, 07:07:01 am by Jim Allen »
HIV 101 - Everything you need to know
HIV 101
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 iamindie

  • Member
  • Posts: 12
Re: suggestions needed - urgent
« Reply #10 on: November 13, 2020, 01:39:31 pm »
Hi Jim
Thanx for yr response
Yes during last check up my doc said my VL 66 is ok
But this time he thought about my loss of weight aŮd added lamivudine 150 mg twice daily

I went to my nephrologist today
He said your ART medicine has some molecules which is damaging kidney. He told me to discuss about it with my ART Doc. But thus Doc says my ART medicine are kidney safe.
Tell me if u have any idea about the effect of medicines I am taking on kidney.

Offline Jim Allen

  • Administrator
  • Member
  • Posts: 16,306
  • Twitter @JimAllenDublin
    • HIV Lessons
Re: suggestions needed - urgent
« Reply #11 on: November 13, 2020, 03:50:32 pm »
Hiya,

Dolutegravir can be given as a 2 drug combo with just the lamivudine.

I am not a doctor.  Consult you doctor on those options.


I would agree with the above.
Was there any HIV resistance profile or something?

To be honest as a patient myself I don't understand the dosage or combination of meds that you are taking at the moment.

Plenty of other options like trying 2 NRTIs + DTG would be a possible combo, Example, Dolutegravir + abacavir + lamivudine.  Since you have Dolutegravir & lamivudine already it's just adding abacavir and dropping the rest.

Quote
He said your ART medicine has some molecules which is damaging kidney. He told me to discuss about it with my ART Doc. But thus Doc says my ART medicine are kidney safe.

Generally, they are safe. Might have nothing to do with the issues you have.
That said, and not to be mean, some of the concerns are not issues.

Talk to your HIV doctor again, ask him about combinations. Stick to the diet, retest when asked to see what the creatinine level situation is after making the diet changes and changes to the hypertension meds.

Jim.

https://forums.poz.com/index.php?topic=69107.0

HIV 101 - Everything you need to know
HIV 101
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 iamindie

  • Member
  • Posts: 12
Re: suggestions needed - urgent
« Reply #12 on: November 14, 2020, 02:25:10 am »
Thanx him
I will soon talk to my Doc
I don't know abacavir us available in India or not

Offline Matths

  • Member
  • Posts: 39
Re: suggestions needed - urgent
« Reply #13 on: November 14, 2020, 05:58:08 am »
Hello, Iím following your interesting conversation. My question is why your doctor or you even consider adding a 3rd medicine to a dolutegravir + lamivudine combination? Generally, it takes a while for some people to achieve VL < 50 or < 20, which I believe is what we all aim for. There is plenty of evidence that adding a 3rd medicine or more to a treatment combo that already suppressed your VL below 200 will add anything. You allies at the moment are patience, adherence and time. I understand itís difficult but with dolutegravir +lamivudine you have a treatment combo that was shown to be highly effective (and seems to work for you too) and safe and my suggestion is to give this combo the time necessary to get you fully suppressed as defined by a VL < 50 or < 20 (depending on your lab). Best Matt

Offline Matths

  • Member
  • Posts: 39
Re: suggestions needed - urgent
« Reply #14 on: November 14, 2020, 06:02:25 am »
To clarify an error in my comment above: there is plenty of evidence that adding a 3rd medicine or more to a combo
Of dolutegravir +lamivudine will NOT add anything. Sorry for the confusion. Best Matt

Offline Jim Allen

  • Administrator
  • Member
  • Posts: 16,306
  • Twitter @JimAllenDublin
    • HIV Lessons
Re: suggestions needed - urgent
« Reply #15 on: November 14, 2020, 07:16:41 am »
Thanx him
I will soon talk to my Doc
I don't know abacavir us available in India or not

No problem. DTG+3TC+ABC is just one of many proven combo's. There are plenty of other combos that could work, just have a look at the link I posted earlier.

Depending on what's available to you, they should be able to come up with a proven combo that will work for you. What I don't understand though is your current combination.

- DTG + DRV + 2x RTV daily + 2x 3TC daily.

Prehaps there are things you have not mentioned that factor into the doctor's drug choice like previous resistance noted? Otherwise, it just seems to be a tad excessive to me. Again its something to discuss with your doctor.
« Last Edit: November 14, 2020, 07:32:07 am by Jim Allen »
HIV 101 - Everything you need to know
HIV 101
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 iamindie

  • Member
  • Posts: 12
Re: suggestions needed - urgent
« Reply #16 on: November 15, 2020, 02:26:21 am »
Hi Jim
A small correction regarding my current combo of medicines

Quote
"Depending on what's available to you, they should be able to come up with a proven combo that will work for you. What I don't understand though is your current combination.

- DTG + DRV + 2x RTV daily + 2x 3TC daily."

It is DTG+ DRV+RTV+2x 3TC daily
My doc says DRV is always given in combination with RTV

Quote
"Prehaps there are things you have not mentioned that factor into the doctor's drug choice like previous resistance noted? Otherwise, it just seems to be a tad excessive to me."

No other factors and I didn't hv any prior resistance to any medicine
I started with DTG + 2x3TC + 2x AZT
After I got liver problems, Doc withdrew 2x3TC + 2x AZT and switched to DRV+ RTV
I mean untill last week I was taking DTG + DRV+ RTV combo. But during this combo I developed kidney problems ( my creatinine level shot up) and my weight wend down by 11 kg.
Doc again added 3TC
So now my combo is DTG+ DRV+RTV+2x 3TC daily


« Last Edit: November 15, 2020, 04:37:38 am by Jim Allen »

Offline iamindie

  • Member
  • Posts: 12
Re: suggestions needed - urgent
« Reply #17 on: November 15, 2020, 02:27:35 am »
Thanx Matths for yr reply.and suggestion.

Offline iamindie

  • Member
  • Posts: 12
Re: suggestions needed - urgent
« Reply #18 on: November 15, 2020, 02:41:11 am »
Afterthought

Jim is abacavir renal safe?

Offline Jim Allen

  • Administrator
  • Member
  • Posts: 16,306
  • Twitter @JimAllenDublin
    • HIV Lessons
Re: suggestions needed - urgent
« Reply #19 on: November 15, 2020, 05:01:22 am »
Quote
It is DTG+ DRV+RTV+2x 3TC daily
My doc says DRV is always given in combination with RTV

Yeah, that correct, well Darunavir requires a booster like Cobicistat or Ritonavir.
https://www.poz.com/drug/prezista

Quote
No other factors and I didn't hv any prior resistance to any medicine

Okay, so then you could even talk to your doctor about just keeping, 50mg Dolutegravir + 300mg lamivudine. So dropping the Darunavir, Ritonavir. Or another combo with just 2 NRTIs + DTG.

Jim

HIV meds: https://forums.poz.com/index.php?topic=69107.0
https://www.poz.com/article/fda-approves-dovato-hiv-switch-option
https://www.poz.com/drug/dovato
« Last Edit: November 15, 2020, 05:03:41 am by Jim Allen »
HIV 101 - Everything you need to know
HIV 101
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 Matths

  • Member
  • Posts: 39
Re: suggestions needed - urgent
« Reply #20 on: November 15, 2020, 09:14:51 am »
An add-on to Jimís posting on the 2-drug combo of dolutegravir + lamivudine is that it was shown that this combo also works long-term. The 3-year data were released recently and show that this combo is as good as a 3-drug combo, and is safe.

https://www.poz.com/article/dovato-posts-3year-marks-par-tivicay-plus-truvada-hiv-treatment

Offline iamindie

  • Member
  • Posts: 12
Re: suggestions needed - urgent
« Reply #21 on: November 16, 2020, 04:16:03 am »
Hi Matths n Jim
Today I met my Doc
And discussed about my on going medicine.
He says as my weight went down considerably ( 11 kg ), he is suspicious of my VL. Ideally it sud be less than 20 but it is hovering around 70.
That's why, considering my weight loss, he added lamivudine  in my on going treatment with DTG + DRV+ RTV
He says he will not take the risk if decreasing medicine because he thinks my virus is not suppressed fully( considerable loss of weight).
He suggested me to visit a reputed hospital(3000km away from my present location) and get consultation. After that he will do anything.

Offline Jim Allen

  • Administrator
  • Member
  • Posts: 16,306
  • Twitter @JimAllenDublin
    • HIV Lessons
Re: suggestions needed - urgent
« Reply #22 on: November 16, 2020, 05:12:57 am »
It's your choice at the end of the day.

Considering the VL is suppressed I would be reducing the meds if I was you.

Anyhow keep us posted on the diet etc. Hopefully next round of monitor the creatinine will drop off again.
HIV 101 - Everything you need to know
HIV 101
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 iamindie

  • Member
  • Posts: 12
Re: suggestions needed - urgent
« Reply #23 on: November 16, 2020, 05:21:12 am »
Quote
Considering the VL is suppressed I would be reducing the meds if I was you.

So, what do u say.
I should leave DRV+ RTV and stick to 2-drug combo of dolutegravir + lamivudine regime.
« Last Edit: November 16, 2020, 06:14:47 am by Jim Allen »

Offline Jim Allen

  • Administrator
  • Member
  • Posts: 16,306
  • Twitter @JimAllenDublin
    • HIV Lessons
Re: suggestions needed - urgent
« Reply #24 on: November 16, 2020, 06:24:27 am »
Quote
50 mg Dolutegravir + 300mg lamivudine. So dropping the Darunavir, Ritonavir. Or another combo with just 2 NRTIs + DTG.

Jim

HIV meds: https://forums.poz.com/index.php?topic=69107.0

Quote
There are plenty of other combos that could work, just have a look at the link I posted earlier.

As mentioned before, if it was me with those results I would be looking at the possibility of 2 NRTIs + DTG. Or considering the DTG+lamivudine.

End of the day it's your health, not mine or your doctors. You need doctors to aid you in making wise decisions but you are the pilot, they are ground control.

Edit that reminded me of the panti bliss video on hiv air.
https://www.facebook.com/GayStarNews/videos/1190317401044575/
« Last Edit: November 16, 2020, 07:00:15 am by Jim Allen »
HIV 101 - Everything you need to know
HIV 101
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 Matths

  • Member
  • Posts: 39
Re: suggestions needed - urgent
« Reply #25 on: November 16, 2020, 06:34:23 am »
Hello again, first and most important, you should work with your doctor since you two build the team in your situation.

What I would do (assuming your VL is 70) and you have to Hep B (or any other Hep), and you have no resistance documented, is to take dolutegravir 50 mg + lamivudine 300 mg daily. Continue monitoring your VL (next check in 1 month, if around the same or less next check in 3 months and if the same VL or less another check in 3 months). Then you will have taken this combo for 6 months which allows a better interpretation of whether this treatment works or not. If you keep changing your medications too often, you will not be able to understand if a treatment works or not. Make sure you take this combo everyday and donít miss a dose.

Of course, if your VL starts to increase with this combo and continues to increase, you probably need resistance testing which then will inform next steps. There are so many medication combos available these days that one  will work for you too.

 


Terms of Membership for these forums
 

© 2020 Smart + Strong. All Rights Reserved.   terms of use and your privacy
Smart + Strong® is a registered trademark of CDM Publishing, LLC.