Question
Should I worry about IRIS if I started Viraday when my CD4 was 10?
1 March 2015. Related: All topics, CD4 and viral load, Opportunistic infections, Starting treatment.
Hello there
I found out I was HIV positive in January 2015. My viral load was 414,000 and my CD4 was 10. I am not having any symptoms nothing except the skin rash.
I started my HIV medicine (Viraday) a week ago and i felt the side effects. Am I now in any danger ?
My doctors said that I am not, and that everything is good thing and it just needs time.
I’ve read all the questions above but still i wanted to ask how much does it take to increase my CD4 and about the IRIS. If IRIS is gonna happen, after how long from starting the medicine does it come?
Thank you a lot.
Answer
Hi
Thanks for your questions.
First, it is good you are now on treatment. You very have been lucky if you have not had symptoms with such a low CD4 count.
Your CD4 count is already likely to be higher, but for most people this will be a slow and steady increase. On average, it might take a years for your CD4 count to increase to 100 and another year to reach 200.
Some people get larger increases and for some people it might take more time.
If IRIS is going to happen, it is usually in the first few weeks or months after starting treatment. This make it very important to talk to your doctor about any new symptoms. Your doctor needs to decide whether new symptoms are side effects or symptoms of IRIS.
IRIS stand for Immune Reconstitution Inflammatory Syndrome. IRIS occurs to about 1 in 4 people starting with a CD4 count under 50. The related infections can include TB and CMV. It is important that your doctor checks your eyes for CMV, especially if you have noticed any chances in your eyesight or vision.
Viraday is a generic version of Atripla.
Your viral load is very low for such a low CD4 count. Did you really mean 414 or 414,000?
Hi Rahul – thanks for your comment and a really important question. The answer might vary depending on which country you live in as recommendations for routine genotype testing depend on how much resistance there is in your country or region. However, even when guidelines recommend resistance testing, your individual situation might mean it is not needed especially if it is difficult or costly to do.
So if you are living in a country where resistance to Tivicay (dolutegravir) is likely to be very low – and this is still true in most countries – then you could hope/assume that this drug will be fully active.
Also, the GEMINI studies showed that dolutegravir is potent enough to only need one other drug to be equivalent to a three-drug combination. So even if there was low level drug resistance to one of the drugs in Descovy, it is unlikely to make the combination any less effective.
On balance, it seems like you would have to be very unlucky for this combination not to work – especially as you are starting with a relatively low viral load.
If the cost makes getting a resistance test difficult, just starting the treatment and checking viral load is a reasonable choice. Depending on access in your country, you might also find that the resistance tests available are not even checking for resistance to dolutegravir, which is the main drug you would want to check for. Dolutegravir is an integrase inhibitor, so checking that the resistance test check integrase is important.
If you let me know your country or region – or ask your doctor about local levels of resistance – I think this answer would still be the same.
I’ve been asked by my doctor to start ART with the generic version of Tivicay + Descovy. My question is, should I under genotypic drug resistance test before starting ART, or should I consider getting it done if my reports do not improve after 3 months? Genotypic resistant test is expensive and I don’t want to get it done unless it’s a necessity. I’m worried about acquired resistant strains of hiv. I know that acquired resistance to dolutegravir is extremely rare, but what about emtricitabine and TAF? Also, will my treatment work if my hiv is resistant to only 1 out of the 3 drugs in my regimen? Thank you!
Baseline CD4 is 255, viral load 34500.
Hi Srikanta,
Do you mean Viraday? This is a generic version of Atripla. If so, take before bedtime, on an empty stomach (or not with a high fat meal). A high fat meal increases drug levels of efavirenz by 60%. This increases the likelihood of side effects.
Taking the pill at night reduces these side effects as you will be sleeping when drug levels are highest.
There’s a lot more general info in this Introduction to HIV treatment (ART).
Hello sir now I am hiv positive detected.my doctor advice for virasat tab .so what is the perfect time for it to take before food or after food and it’s better to use before go to bed or in day time.please sugest