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what blood test should I take to monitor my health when I take ARVs...
Jun 29, 2012

My dear Dr Benjamin Young, Hi, Glad to be in contact with you again, Its me Wilmer J. from Nicaragua. as you may recall I was diagnosed with HIV november 26th 2011... my doctor began treatment with combivir(lamivudine and zidovudine) and efavirez on dec 8th... 5 days later due to strong nervous problems my doctor changed efavirenz with kaletra(lopinavir, ritonavir) I am not proud to remind you that i was not adherent for the first month,,, due to many problems. it was until january 4th till today that i do not miss a pill. 1st test on nov 29th 2011 cd4 80 vl 202000 2nd test on mar 1st 2012 cd4 181 vl 101 i have been taking bactrim as well every day until now... 3rd test on june 1st 2012 i will have cd4 results next july 2nd. recently i had a strong flu with high fever my doctor told me to take clamicil... amoxiciline and clavulanic acid... i took it for 5 days first...two weeks ago and a week later for 7 days... i stopped with the antibiotics 4 days ago... yesterday i had a blood test... results in spanish... sorry eritrocitos 3.55 millon-mm3 hemoglobina 14.1 g-dl hematocrito 40.2% indice eritrociticos...VCM 113.0 chcm 35.0 hcm 39.6 globulos blancos leucocitos 4.1 celulas en banda 0.0 segmentados 47.1 linfocitos 33.9 monocitos 13.8 eosinofilos 4.5 basofilos 0.7 all are percents... platelets 564 miles-mm3

my questions... (sorry for the amount of ????? )

1st... what medical blood test are important to monitor the possible side effects of the arvs that i take...

2nd... how was my results of my biometria hematica completa

3rd... i have been with the flu... now i have a dry cough... the antibiotic controls it but ... isn't it dangerous to be taking antibiotics as well... should i continue taking it... i still feel bad...

4th ...on june 1st they also made the following tests BHC TP TPT glucose creatinina HDL colesterol trigliceridos TGO TGP bilirrubina total bilirrubina directa VDRL toxoplasmosis IgG IgM hepatitis B hepatitis C... I will now the results on july 2nd... how convenient are these tests ... in there anyone that I should take and it is not in the list... in that case i will have to do the test by my own...

5th ... here in nicaragua they offer truvada and efavirenz first... and combivir and kaletra as a second option... THERE IS NO RESISTANCE TEST PRIOR TO DECIDE THE MEDS UNFORTUNATELY... what would be the possible reason... i did not receaved truvada... you may recall that my partner began on june 15th his treatment with truvada and kaletra... what is the difference between truvada and combivir...

thank you so so so much for your help... I really admire you... I read all your answers... I strongly believe that this desease can be controled ... but we need as HIV positive... INFORMATION,,, reliable information on what to do and how to do it... you help ALL of US to save our lifes... thank you DR young... i wish i could be in contact with you more often...

i will receive my cd4 results on july 2nd and vl on august 2nd... unfortunately that is the way it is here in nicaragua... the results last 1 month for cd4 and 2 months for viral load...

i have other concerns,,, i will write you again on july 2nd after i have my cd4 result. thank you so much for your huge patient and your answer I really admire you!

Response from Dr. Young

Estimado Wilmer,

It is good to hear from you again and thanks for your nice words.

1) We usually try to do laboratory and clinical monitoring every 3-6 months in patients living with HIV. A typical set of tests includes a complete blood count (CBC), chemistry and kidney/liver function panel, CD4 count and HIV RNA. In addition, every 6-12 months (depending on situation), urine tests (for sexually transmitted infection and protein), fasting cholesterol and triglycerides are tested. For more information, I'd suggest looking at the US DHHS Treatment Guideline recommendations for laboratory testing.

2) The CBC (biometrica hematic completa) looks fine and within acceptable ranges.

3) If indicated, it's not dangerous at all to take antibiotics. The one that you're taking (amox/clavulanate) is widely used and generally very well tolerated.

4) The additional tests your doctor has ordered include the liver function tests, lipids (cholesterol and triglycerides), tests for sexually transmitted infections (VDRL) and hepatitis virus infection. These are all recommended tests and can help with clinical management.

5) While HIV drug resistance testing is recommended prior to starting medications in the US and Europe, it is not universally performed, usually because of costs or local laboratory ability. The main issue is the risk that you might have acquired virus that may be resistant to one of the medications that you were taking. This is particularly of concern for efavirenz- since widely prescribed, it's also the drug that viruses are most commonly resistant to. This is rarely the case for Kaletra, so your current regimen has little risks with regard to transmitted HIV drug resistance.

Truvada and Combivir are two different NRTI combinations- both are popularly prescribed and recommended in different parts of the world. Combivir is associated with slightly greater risks of side effects (nausea, head aches, anemia for example) and is dosed twice daily. Combivir is no longer a preferred first-line NRTI combo in the US, but is widely prescribed world wide. Truvada is more commonly used here in the US and Europe, is dosed once-daily and very well tolerated. It is occasionally associated with kidney injury and loss of bone mineral density. For more information about first-line HIV medications, I suggest looking at TheBody.com's Resource Center on Starting HIV Treatment..

Feliz fin de Junio. Write back anytime. BY



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