Sunday, April 27, 2014

I'm now Undetectable

After 9 months of ARV, my HIV Viral Load is now < 34 copies/ml. This means, the HIV viral load in the blood is undetectable, meaning it is too low to be detected by the current test. Hooray! My HIV is now under control and is no longer replicating, thanks to ARV. Unfortunately, this also means that my CD4 will rise in a slower pace. I'm just at 93 now, with a CD4% of about 8%. Anyway, I feel well now and don't have OI's. 

Thursday, April 17, 2014

Part 2 - Would You Rather Have Cancer or HIV?

Two months ago, I posted a blog Would You Rather Have Cancer or HIV? And my answer was I'd rather have HIV. I still have the same answer now. 

Meet Brent. This guy is in his early 30's. Doing well at work, and earning a decent salary, in fact more than what an average guy his age does. He's managing a number of employees, giving directions and leading them to achieve their unit goal. He works out at the gym 3 times a week. He's got a fit body, and looks so damn healthy and buff. He leisurely travels a lot, sometimes by himself, and sometimes with his friends or family. Every summer, he goes to the beach to enjoy the sea. He also parties in clubs, though he only drinks at most one bottle of beer. Ironically, every month, he goes to a medical clinic for checkup, and to get a bunch of medicines. He needs these to keep his viral load down. Yes, that's right. He needs lifelong ARVs to keep his HIV viral load in control. He has been positive for 5 years. Five years back, when he was diagnosed as positive, he was classified as a clinical stage 3 (the most advanced stage of HIV), with serious OI's like pneumonia and meningitis. It was such a battle, fighting those serious OI's. He had shortness of breath, literally grasping for air.  Had high fever and nausea. He vomited. Had bitter tastes on any food. Had severe headache, and allergies over his body. He lost a lot of weight. He stopped working for 8 months to completely recover. Fortunately, 5 years later, he has completely gotten his life back. He looks just as normal as any healthy guy his age does - very far from how common people imagine how PLHIV look like (malnourished, severe skin lesions, bed ridden). Yes, he has completely overcome his OI's,  and has regained his CD4 count back to normal level. He still has the HIV virus within him, but it is definitely under control, with a viral load that is undetectable. 

Meet another guy, James. This guy was sick. One time, he passed out while walking. Because of this, he underwent a radiation treatment as advised by his physician. He lost his appetite, and stopped eating a lot. He had nausea and vomited, and was just staying home. He had shortness of breath when walking even just a few steps. His breathing got worse and worse, until he was rushed to the ER. He was given oxygen for breathing. He improved slightly. But as days passed, his oxygen requirement kept on increasing, until the doctor inserted a tube attached to a respirator in his mouth. His labs showed that he had severe pneumonia infection, and there was already water in his lungs. His cancer cells have spread uncontrollably to his lungs. While in the hospital, he was being treated for his pneumonia. Right, pneumonia can be treated. But the problem was, when pneumonia is resolved, the cancer tumors will remain in his lungs. And those cells may continue spreading not just to his lungs, but to other organs as well.  We all know that there still is no cure for cancer at an advanced stage. So, it was like a battle with no foreseen victory in the end. A tunnel with no light at the end, not even a small light bulb, nor a tiny candle light. What the doctors were doing was just to treat the infection, but not the cancer that is causing of infection.  It was a stop gap solution... and was merely prolonging for a few weeks his already limited life. As expected, since it was an advanced CA case, he got worse each day. Water and air continued to build up in his lungs, that further burdened his breathing. Infection progressed further. He was no longer moving his body and arms as much. Each day, his breathing got worse, even with a respirator. It was an agonal breathing. He felt some pain, here and there. Until, he fell into a coma. His blood pressure decreased slowly as days passed, until no pulse can be heard. It zeroed, then he passed away. After more than one month of struggle in fighting his pneumonia, he passed away.  

Two different cases. Both are immuno-compromised. One had hope, the other had none. I know a lot of PLHIV who are like Brent. They completely got their lives back, and are now back in their ball games. I myself is a person living with HIV. I'm still in the process of recovering my immune system, but I'm on the right track. One day, I'm sure I will be like Brent. 

Certainty, to me, between the two guys, I'd rather be Brent than James. So, I should be grateful and should be rejoicing for I have is Brent's case, and not James'. And I am almost certain I'm gonna be like Brent in just a few months or years. But, I'm not rejoicing now! Why? Though I'm not James, James happens to be someone I know. He happens to be my mom. 

It's hard enough to be sick with HIV. But it's even harder to be sick with HIV while your mom is sick with cancer. We are both immuno-compromised. We can't be near each other, as we got sick at the same time. I could get her infection, and she could get mine. She can't visit me when I was in the hospital. Likewise, I couldn't visit her as much when she was confined. It's sad to see your mom suffer, slowly get weak, and eventually lose her due to cancer. And it's even hard to mourn, since I need to control my emotions. I can't be too sad for this could cause my CD4 to plunge. It was a difficult scenario, the most difficult in my life.  

But, knowing how my mom lived her life - with all her good deeds, with all her positive influence to other people, I'm sure she is now at peace with the Lord in His kingdom. Imagining that she is now, having eternal peace and joy, singing and praising with the angels in heaven, and comparing it side by side with the time she was grasping for air and in pain in her hospital bed, I'm now at peace! For she is now in a far better place than where she was - a place where there is no misery, no worry, no pain, nor discomfort. A place filled with love, joy and eternal happiness. It's not true that there's just darkness at the end of her tunnel. With the place where she is now, I'd say the end of her tunnel was not a tiny light from a candle stick, nor a small incandescent bulb, but a light so bright that is unimaginable to us humans.  This gives me relief and peace. This give me comfort, gladness and joy. 

Now knowing that my mom is in a place far better than ours, I'll keep fighting my own battle. I will keep my immune system up. And I promise to be Brent in no time. I will definitely be victorious! 

Have a blessed holy week!

John 14:1-4
“Do not let your hearts be troubled. Trust in God; trust also in me.  In my Father’s house are many rooms; if it were not so, I would have told you. I am going there to prepare a place for you. And if I go and prepare a place for you, I will come back and take you to be with me that you also may be where I am. You know the way to the place where I am going.”

Revelations 21: 18-21
"The wall was made of jasper, and the city of pure gold, as pure as glass. The foundations of the city walls were decorated with every kind of precious stone. The first foundation was jasper, the second sapphire, the third agate, the fourth emerald, fifth onyx, the sixth ruby, the seventh chrysolite, the eighth beryl, the ninth topaz, the tenth turquoise, the eleventh jacinth, and the twelfth amethyst. The twelve gates were twelve pearls, each gate made of a single pearl. The great street of the city was of gold, as pure as transparent glass."

Wednesday, April 16, 2014

It's Sadder To Have a Loved One in a Hospital

Yesterday, due to a medical emergency, a family member was rushed to the ER. When I was on my way to the hospital, last year's events, particularly my hospitalization, flashed back. I remember the time when I was being brought to the hospital for my pneumonia. During those times, though my condition was serious enough, I was not as worried, as bothered and as sad as I am now.

Now, it is a different case. It's not me who's in the hospital. It's a loved one. My mom. Then, came a realization. It is truly sadder and more worrisome to have a loved one in the hospital, than to have yourself confined. My OI's then flashed back to me, pneumonia and meningitis. On hind sight, damn, they were pretty serious, especially my CD4 then almost reached a single digit. Now, I just can imagine how my family, partner and friends were feeling while I was in the hospital.

So, I realize, I need to get well and overcome AIDS fast, not just for me, but more importantly for the people who love and care for me. I owe my complete recovery not just to myself, but to them as well. 

For the meantime, I pray for my mom's recovery. At the same time, I need to control my emotions, as I don't want my CD4 to plunge. 

Note: Written weeks ago.

Saturday, April 12, 2014

Calculus is Not for Grade School

Calculus is taught in college, while basic arithmetic is taught in grade school. Never ever attempt to teach calculus to a grade 1 pupil. It just never works! People have different levels of comprehension and capacities to understand. It's a reality of life. Accept it. 

Choose your battle. Not all are worth fighting for, and certainly not all are worth a count of your CD4. 

Meanwhile, here is Boo, the world's cutest dog. This dog never fails to make me smile :) 

Friday, April 11, 2014

My Low CD4: TheBody's Opinion

In my last blog, I emailed my latest CD4 result, which to me was still very low. I felt sad about the slow increase in my CD4, to be honest, and starting to be disheartened. So, I asked TheBody's doctors regarding their opinions. Here's their response.

Low CD4
Apr 9, 2014

My baseline CD4 in June 2013 before I started ARV was 14. After 10 months of ARV, it's now 93. I have no Viral Load results yet. I will get my first VL result in 2 weeks. Here's my trend:

Date - CD4 Count - CD4% - Lymphocyte Count - WBC: June, 2013 - 14 CD4 - 1.77% - 774 - no WBC data; Sept, 2013 - 90 CD4 - no data - no data - no data; Dec, 2013 - 77 CD4 - 4.98% - 1548 - 5.14; Apr, 2014 - 93 CD4 - 8.32% - 1116 - 4.2;

My latest CD4 is only slightly higher, though my CD4% almost doubled, but lympocyte and WBC are lower. 

Could it be because I had colds 2 weeks before the test, and if I had no colds, my CD4 could have been higher?

After reading your past responses, I would expect that my VL is now undetectable (having been on ARV for 10 months). Now, I'm worried that with an undetectable VL, my CD4 would then rise even slower? If so, do you think it's likely that that I could reach 200 within 2014?

Also, my doctor advised me to refrain from going to public places until my CD4 rebounds to 200. If it can't be avoided, he advised me to wear a mask in public place. Is it really that high risk for people with CD4 of 93 to occasionally go out in public places like restaurants, fitness gym, or uncrowded cinemas, or even fly in a plane?
Response from Dr. Young
Hello and thank you for posting.

Your CD4 count results are excellent ones an indicate your initial immune system recovery from very advanced illness. The CD4 percentage rise is often the most reliable marker of change and the increase from 1.8% to 8.3% is entirely consistent with a strong virologic response. Having a respiratory tract infection can indeed influence CD4 counts, especially the absolute count. For this reason, I generally don't recommend having the test done within a couple of weeks of any acute illness-- you do fall right on the edge of this timeline.

CD4 counts typically increase about 150-250 cells in the first year of treatment- sometimes less for people who start treatment with low counts like you.

Why hasn't a viral load test been done? Do you live outside of North America or Western Europe? Many places outside of high-income countries do not yet have viral load tests, though they have been recently recommended for monitoring by the World Health Organization for all countries.

As for going into public places, I don't share your doctor's concerns. If you're on treatment, have an increasing CD4 count (and presumably undetectable viral load), your risk is not significantly elevated. Just wash your hands from time to time with soap and water- this will decrease the risk of common colds and the like.

Be well, BY

Dr. Young's response was very encouraging. It put me in high spirit again :) My immune recovery is excellent, and I should be happy about it. Regarding going to public places, yes, I agree that perhaps the environments in first world countries are different from the Philippines, and this could be the reason why my HIV doctor didn't want me to go as much to public places without a mask.  But in any case, I don't plan to go to crowded malls, like Megamall and Trinoma just to stroll. I'm fine with occasionally going to uncrowded new malls like Century City, Aura, Jazz Mall, or even to popular malls as long as it's very early or very late to avoid crowd. And I always bring alcohol in my pocket anyway. I'll wait for my VL result. Hoping for an undetectable level. 

Again, sometimes, I tend to forget that I had a very advanced AIDS illness upon diagnosis. A mere recovery from all my major and serious AIDS OI's is miracle enough... a battle against death. And the improvement that I had so far from a CD4% of only 1.8% to 8.3% is something that can be considered already as remarkable! So, this should be enough encouragement for me!

Monday, April 7, 2014

Anxious of Annual Physical Exam

I had my Annual Physical Exam a week ago. I didn't want to have this test. But unfortunately, it was required by my employer. Worse, Pasig is requiring all employees to have mandatory drug tests.

This is the first time I got nervous of an APE. Why?  Because my HIV drug, efavirenz, can yield a false positive drug test result.

Oh well, I did what a guy in a support group suggested. I drank a bottle of Coke, and 1.5L of water before the test, and tried to pee as much as I could. Right before I went to the clinic, I peed one more time. Damn, my urine was still too yellowish when put it in the vial. Could be due to my TB prophylaxis, Isonazin + Rifampicin. Anyway, I had no way out. 

I signed the drug test consent form. It asked if I took medicines for the past 30 days, and if yes, I needed to list them all. So, I lied in the form. What would the doctor and my HMO say if they found out I've been taking Lamivudine, Tenofovir, Efavirenz, Fluconazole, Isonazin+Rifampicin, Cotrimoxazole, Azithromycin? It's a giveaway!

The form is also asking for my consent for the clinic to send the urine specimen to DOH's confirmatory lab in case the initial urine screening yields a positive drug result. So, this gave me relief. Coz, I know that the confirmatory test will definitely yield a negative result.

But, in any case, I already thought of an excuse, in case they ask why the first screening resulted positive. I'm gonna say it's because of the Chinese herbal supplements that I have been taking. It's supplement (not medicine), so i ticked NO meds for the past 30 days in the form. If they asked what supplement? Well, I forgot, since it's in Chinese characters! And, it is actually none of their business. They can send my urine specimen to the confirmatory lab all they want, and I'm sure it'll turn out negative! That's the only thing they need to find out.

I also got nervous of the physical exam by the doctor. Why? He will definitely ask if I have been hospitalized for the past year. I was planning to lie, but decided not to. I'm sure the doctors of the HMO will not immediately correlate my pnemonia hospitalizion to HIV. My pulmonologist misdiagnosed my pneumonia with asthma... how much more a neophyte doctor of an HMO with a few years of practice? And even if I said I was not hospitalized, I'm sure their systems are not interconnected, such that it will check my HMO claims to verify my response. We are not in a first world country with advanced IT systems! Luckily, as it turns out, there was no physical exam this year. I don't know if they only forgot to check me, but I'm glad there wasn't. I don't expect much from an HMO doctor doing the APE. I'm sure my HIV doctor (who happens to be a UP professor and PGH consultant) is far better, whom I consult regularly anyway.

So there... I finally finished my APE. Today, I got my results. Normal chest findings. Good, I don't have pneumonia. Normal BMI. 20/20 vision. But I have high cholesterol. I kinda expected this, as this is one of the side effects of my ARV. I will have to check with my ID what to do with my cholesterol. I guess I now have to start eating the yucky oatmeal daily. 

Sunday, April 6, 2014

Sigh... CD4 is Still Low

Sigh! CD4... why do you take so long to go up?

CD4 Count
Lymphocyte Count
June, 2013
14 / uL
774 /uL
Sept, 2013
90 / uL
Dec, 2013
77 / uL
1548 /uL
Apr, 2014
93 / uL
1116 / uL 

I haven't consulted my ID yet on my latest CD4 result. It seems like the CD4% did a good increase, but the absolute CD4 count didn't increase as much. Hope it's just because my WBC was just low during my blood extraction (probably due to common colds), since my latest lymphocyte count was lower than in Dec.