Question
How quickly should my CD4 and viral load change after starting meds?
20 May 2008. Related: All topics, CD4 and viral load.
7 weeks ago, I was started on Kivexa (abacavir+3TC) and Stocrin (efavirenz), all once daily.
I do feel better – however I am worried about treatment failure as I still feel very very tired. My viral load was 24,000 copies/mL and my CD4 was 230. The question is: How soon will the combination work against my viral load and how soon will the CD4 count begin to rise?
Thanks for this forum, which is absolutely needed. I am living in Denmark and there is no such thing. To make things even worse right now there is a health strike in Denmark so nothing works.
Answer
Thanks for your question.
Viral load responds to treatment very quickly – probably by one ‘log’ in the first few days (ie from 24,000 to 2,400) and another ‘log’ in the next week or two (from 2,400 to 240). A ‘log’ is a factor of ten and an easy way to see a log is to knock off the last number.
No-one has their viral load measured this early except in research studies, so guidelines say your viral load should drop by at least one log in the first month and be less than 50 copies/mL (undetectable) within the first 3-6 months).
CD4 responses can vary a lot. Although some people get quicker rises, slow and steady increases are probably better. As long as your CD4 count is over 200, then your risk of any HIV-related complication is very low.
If you feel tired, then talk to you doctor about this and fatigue can be a symptom of some rare but serious side effects.
Stocrin (efavirenz) can cause sleep disturbance (because a side effect includes vivid dreams or nightmares), and if you are not sleeping well, this may explain why you are tired. See this link for more info.
You can order it (free of charge) from: http://www.i-base.info/forms/order.php?guides=true
Where is this book and how can
I am on Truvada (tenofovir + FTC) and efavirenz and have been for 4 weeks now.
At the start my side effects were quite serious (dizzyness, nightmares and night sweats), but these have all settled down. I still get the night sweats and sometimes have dreams that seem so real they make me feel quite panicked – but I am assured by my cnsultant that these really do settle down. Try and hang in there and maybe try some self help with your fatigue.
I still feel very tired but I noticed the other week that there was a new manageging side effects book from i-Base which you kindly sent me through the post and it has some great tips around how to manage the fatigue, for me the biggest one was trying to cut out the caffeine and also eating at an appropriate time.
Since trying different eating times and also replacing the coffee with a herbal drink at night I seem to be sleeping much better.
Have a look at the book…. It is really great.
Thanks for your quick responce – and for your detailed answer which helped me.
Obviously I wonder if my side effects (still having very vivid dreams and being unable to sleep through the night – I wake up at least every two hrs), is considered serious side effects – and therefore recommends shifting from Stocrin? … or if I should just hang in there and carry on for a longer period. (the dreams have changed from nightmares to more mixed dreams, and a strong anemea has lifted. Once a week a feel very dizzy after taking the meds….but not every night as I used to during the first 4 weeks of medication. I have been trying to talk to my HIV doctor about it, but due to the strike I am not able to get an appointment.