Working on Yachts

Question

Hallo Doctor. I was diagnosed 8 weeks ago with HIV when I was hospitalized with a acute throat infection. My Viral load was in the millions and CD4 count was 350. I immediately started ARV's and 5 weeks ago switched to Atripla.I fully recovered from the hospital and changed my lifestyle to the fullest! I stopped smoking, drinking, regular exercise and changed my diet completely. I am now applying for a job on a yacht and need to do a Seafarer Medical examination. I went to my physician yesterday that prescribed the Atripla for a blood test. My CD4 has dropped to 220, and viral load to 2000 from the millions. In order to be fit for sea with no restrictions my CD4 count needs to be above 350 and no reasonably foreseeable risk of disease progression from side effects of treatment. Did I do the test too soon after my hospital "session" and what is the possibility for my CD4 count to go up more then 350? How long does it take for the meds to show "improvement"? I am 28 now and hope my dream of working on the yachts is still possible.

best, Cpt. SOUTH AFRICA

Answer

Hello Captain South Africa,

Sorry to hear about your recent HIV diagnosis. Your recent laboratory results are consistent with your clinical course and previous results. Atripla is working well virologically. Your HIV plasma viral load has plummeted from the "millions" to 2,000 within several weeks. This is excellent news. Immune reconstitution (increase in CD4 count and CD4%) is expected to occur over time as the viral load is suppressed, hopefully to undetectable levels. Although there are no guarantees, I would strongly anticipate your CD4 count will significantly increase if your viral load remains significantly suppressed (hopefully "undetectable"). How quickly and to what degree immune reconstitution occurs varies considerably from person to person. Your decision to stop smoking and drinking, begin a regular exercise program, and improve your diet in addition to taking combination antiretroviral therapy will improve your chances for significant immune reconstitution.

I would say your chances of fulfilling your dream to work on yachts are excellent. Continue to work closely with an HIV specialist and keep a positive attitude about being positive. It's the best way not to let HIV spoil your dreams.

Good luck. I'm here if you need me, OK?

Dr. Bob