First Time HIV Check-Up

[VersatileBreeder]

Hey guys. Yesterday I went to my ID doc for my first blood draw to test the med's progress. Doctor said "hopefully this will be the test where we see the virus suppressed to undetectable levels, or at least very low." They drew right vials of blood and I should have results next week.

I don't know why, but I'm so nervous about getting these test results. I've been on Stribild for about 7 weeks now and have had perfect adherence. Haven't missed a day and always take it within an hour or two of 10 AM. I just have this bad nervousness that the doctor may call me back with bad news- viral load not down, CD4 not up, etc. I know I probably shouldn't have these fears but for some reason they're hanging over me.

Has anyone had similar experience when going for their first check up? Are these fears irrational?

[fillmyholeftl]

Was always anxious for the first few blood draws. but, rest assured, your levels will be undetectable or VERY LOW & you'll have a high CD4. Strilbid has great results... let us/me know how you make out. Happy & SAFE (hahaha) 4th

[jtonic]

They're not irrational fears. Each test will bring its share of stress, whether that's today or in 10 years. For what it's worth, my ID doctor says that most patients in 2014 achieve a very low or undetectable viral load within 3 months, or faster. Even if your results are not what you hope for, it could just be a matter of time, or worse case, you'll be taking different meds 3-6 months from now, then you'll be undetectable. Just follow their advice, one appointment at a time.

As far as CD4 count, I'll reiterate what my staff keeps telling me. Don't read too much into that number, especially at the beginning of a treatment. Yes, the trend matters over the first 3-6-12 months. But don't freak out if CD4 hasn't increased substantially after 7 weeks. Finally, don't compare your cell counts to someone else's - it's not an absolute measurement of someone's health.

The important thing is that you've adhered to your meds. So you're doing great. Stribild obviously hasn't given you major side effects. You'll be fine, regardless what the results are. I'm sure this is just the beginning towards even better news in the future.

[bearbandit]

If it's any consolation, even after all these years (diagnosed 26-1-87) I get tensed up at results time. It's human nature. Stribild for seven weeks will have put the virus into its place: the highest number I'd expect would be three, maybe four digits. The lowest of course, undetectable. I can't take Stribild because it contains tenofovir, to which I'm seriously allergic. I'm waiting for dolutegravir (also in Stribild) to be made available as a single drug here, but I'm not holding my breath. The integrase inhibitors, like dolutegravir and raltegravir, I believe are going to cause just as much a revolution in HIV treatment as protease inhibitors did in the last nineties.

Expect a low VL, but don't be surprised if your CD4 count takes a while longer to build up to what's normal for you. The CD4 count always takes longer to recover and you very probably don't know what the starting figure (the "normal for you" figure) was. By the "normal for Steve" figures I'm anaemic at present as I've always been at the top end of the generic normal for men figure and now I'm a couple of points below it. I'd urge you to keep a record of your blood results: that way you'll get an idea after a few more vampire visits how things are going. If you graph the figures the CD4 should be going uphill and the VL downhill. As a friend of mine says "it's the trend that counts".

I'm a believer in hitting the little bastard hard and fast - the hell with having to reach a certain CD4 count. Wishing you the best of luck when the results come in...

[lower_bucks_bottom]

Don't get hung up on the term "undetectable". It just defines how good the lab and tests are. Some day undetectable will be zero and then none of us will be undetectable, but we won't be any less healthy. The Partner Study used 200 as their definition, so anything less then that should be fine

[bearbandit]

Undetectable refers to the amount of virus circulating in the blood. There is always some virus hiding in lymph glands and the gut, and semen appears with most drugs to have a higher viral load than blood. Integrase inhibitors are liable to prove very important as they have deeper tissue penetration than other drugs. Twice last year my viral load came back as zero, which I attribute to raltegravir/Isentriss: both times I checked with doctor, nurse and pharmacist, I was so stunned. It's not a cure: the virus is still hiding in various tissues, but it does imply that the viral load of semen will be lower.

[VersatileBreeder]

At this point, I just want to see a significant downward trajectory in the viral load and upwards of CD4. Undetectable would be great, but if the doctor tells me I went down to let's say 500, 1000 or even 2000 viral load from 70,000, I would see that as a success. My CD4 was 700 last test so as long as I'm still at least that, that would be great. Results should be in this week.

[fillmyholeftl]

Don't get hung up on the term "undetectable". It just defines how good the lab and tests are. Some day undetectable will be zero and then none of us will be undetectable, but we won't be any less healthy. The Partner Study used 200 as their definition, so anything less then that should be fine

The "standard" for undetectable in the US is less than 20 copies/mL. Some labs may still quantify as less than 50 copies/mL.

[wood]

good luck man, glad to see you are in a better mental sate now. Oh BTW. have you quit smoking yet!?

[VersatileBreeder]

good luck man, glad to see you are in a better mental sate now. Oh BTW. have you quit smoking yet!?

Hey wood, thanks man, we'll see how it goes this week. I wish I can say yes, I did quit smoking but I have not yet. I am working on it though. Spoke to the doc about possibly getting on Chantix. It's definitely becoming more and more of a must that I need to quit, the doctor also ran some breathing tests on me and he believes it's causing me to have asthma. So definitely in progress. My plan is to be cgi free by the end of the summer.

[VersatileBreeder]

good luck man, glad to see you are in a better mental sate now. Oh BTW. have you quit smoking yet!?

Hey wood, thanks man, we'll see how it goes this week. I wish I can say yes, I did quit smoking but I have not yet. I am working on it though. Spoke to the doc about possibly getting on Chantix. It's definitely becoming more and more of a must that I need to quit, the doctor also ran some breathing tests on me and he believes it's causing me to have asthma. So definitely in progress. My plan is to be cig free by the end of the summer.

[fillmyholeftl]

I definitely don't want to be "Debbie Downer", especially with my friend :-) But smoking is one of the worst things you can do for your health when your are HIV +.... you'll succeed in quitting good luck this week

[otebbtop]

This is a pet peeve (i'm sometimes easily peeved). Why don't more physicians order the labs to be drawn at least a week prior so there are results to discuss at your visit?

Smoking - I do and it's terribly hard to quit. I have had success in the past by using the Nicotrol inhaler. I have it now but just need to take the leap and use it. The prescription is expensive. You get a little inhaler that you fill with nicotine cartridges and puff on when you feel the urge for a cig (or I guess "a fag" for your Brits). Even if you stay on Nicotrol for an extended period - it's certainly cheaper than cigarettes.

When you quit - resist the urge to "have just one" after you've been tobacco free for 6 months - that has always been my downfall.

I was planning to blog about another item - what is with the new fad of "smokin" porn (at least it appears to be new to me).

The old saying "Kissing a smoker is like licking an ashtray.

Edited July 8, 2014 by otebbtop

[bearbandit]

Smoking: poptronic, I stopped cold turkey. It's a question of choosing your time right. PM me if you want more details.

otebbtop: as someone with a now unrealisable smoking fetish - I used to like moderately dark 7" or so cigars and I couldn't help but inhale - it is possible. I've lost about 30% of lung capacity to smoking, which is why I say I can't afford to go back. The smoking porn has always been there: I used to help run CigarmenUK back in the nineties, it's just with the increase in society's disapproval of smoking in any for, it's become more obvious and more transgressive. I remember Bear magazine doing a cigar special in the mid nineties (at a time when Bear was considered by UK customs). Fortunately our copy got through and was practically ripped to pieces at our regular CigarmenUK meetup on a Sunday afternoon. The "new wave" of cigar porn gets to me: I keep thinking of ways I could put it into action without inhaling...

My only experience of giving up tobacco has been as a user (ie I'm not a counsellor) but if anyone wants to give up smoking, I'm happy to support you.

[Poz1956]

Some day undetectable will be zero and then none of us will be undetectable, but we won't be any less healthy.

Sensitive real-time polymerase chain reaction (RT-PCR) assays have an HIV RNA detection limit below 1 copy/mL of plasma. It's just horribly expensive, and usually only used in research studies.

A 2012 French study used RT-PCR, and looked at 1392 people who had a viral load <50. 34% had a completely undetectable viral load, 44% had a viral load between 1 and 20, and 21% had a viral load between 20 & 50.

The greatest predictors of having an completely undetectable viral load were:

- having and VL <50 for two years or more

and

- a highest ever viral load of of <100K

Taking regime that included an NNRTI increased the odds.

Pop: I think getting nervous about the blood test results is natural. I still get a little on edge, and I've had an undetectable viral load since the fall of 1999, with never a single blip. CD4s took a lot longer to recover from a low of 89. It was a few years before they settled into an almost sine wave pattern between the lower and upper 400s. The last set was a surprise in the upper 700s. I'll believe that number when I get a second result in the same neighbourhood.

I'm sure your numbers will be just fine.