2ND WEEK AND 3RD WEEK OF ARV TRIAL

I SURVIVED THE 1ST WEEK . . . 

My second week on Lamivudine/Tenofovir/Efavirenz was pretty much great. Although the only drug that is really dominant I can say is Efavirenz. I take it every 9pm and around 10-10:30pm I already go to sleep and I usually wake up again in the middle of the night (around 12mn or 2am) with the feeling of NUMBING SENSATION & HOT FLUSHES (it's like heat is trying to push its way through my skin) I just usually find a comfortable place to sleep which is in our living room and turn on the Fan in full power and within an hour I fall asleep.

Other than the numbing and hot flushes I don't feel anything unusual not until on the 19th just the morning before the 30th AIDS Candlelight Memorial Celebration. I tried an old pants in my closet which was not cleaned fro more than a month and 30 minutes after.....

Rashes started to appear on both inner thighs... Since I see it as a cause of some allergic reaction I took Antihistamine right away and observed for further changes. 

Celebrated the 30th International AIDS Candlelight Memorial in the afternoon. Because I was so busy with the event I was not able to notice any changes not until I went home around 8pm and noticed the rashes still spreading now in both my arms and feet. 

That day Monday (May 20,2013) I immediately called my boss and asked permission that I will be absent and head straight to my treatment hub to seek consultation. Immediately the resident physician assigned to me started and IV Heplock and started on Hydrocortisone 200mg and Chlorphenamine Maleate to prevent further allergic complications.

My laboratories were all normal. In the afternoon my doctor advised that I go home and take some rest and prescribe some medications for my allergy. Our main attending Doctor advised me also to seek a second opinion from a dermatologist to really rule out any possible underlying condition.

Next day Tuesday (May 21,2013) I went to SM City Iloilo to look for a Dermatologist on duty in a Skin Clinic. I sat down and then discussed what happened prior to the occurrence of rashes. She also examined my rashes and concluded that it's similar to insect bites and so probably it was Dust Mites from the old pants that I tried. She prescribed some topical Hydrocortisone and Some Antihistamines and then I head straight home to get some rest and to prepare to go to work again the next day.

May 22,2013 went to work and basically had a great day and didn't feel anything unusual. My rashes are starting to fade away. 

May 23-29,2013 I can say that my body is partially adjusted to Efavirenz, I just feel the usual NUMBING and HOT FLUSHES but other than that I'm feeling perfectly fine.

I'm done with my 3rd week and I can say that I feel better now. 

This ends my ARV diary for my 2nd and 3rd week of trial.



JaKe Positive. BE SAFE! +)

First week of Anti-RetroViral Medication

 

 

Due to my low CD4 result taken last April 17,2013 which revealed 107 cells/µl, a shocking 75% drop from my last year which was 408 taken July 11, 2012. My doctor advised me to start with Anti-Retro Viral Medication Regimen.

 

My Anti RetroViral (ARV) Drug Combination

I started my ARV Tuesday (May 7,2013).

Lamivudine 150mg (Small White Tablet), Tenofovir 300mg (Big Light Blue Tablet)

I take Lamivudine 150mg + Tenofovir 300mg at 9 in the Morning

 

Lamivudine 150mg (Small White Tablet), Efavirenz 600mg (Big Peach Tablet)

And Lamivudine 150mg + Efavirenz 600mg at 9 in the Evening

HERE's MY ARV DIARY

DAY 1 (Tuesday, May 7,2013)

 Felt nothing unusual. Whole day was Normal.

DAY 2 (Wednesday, May 8,2013)

Woke up feeling drowsy and felt like I had a hangover. I can compare it to taking anti-histamine but this time i don't feel light-headed... my head was heavy.

My appetite was not good. I did eat but was not able to enjoy what I was eating the whole day.

DAY 3 (Thursday, May 9,2013)

Woke up 2 in the morning and I felt the Efavirenz having its peak. I was trying to sleep again but I can't and so I played some soothing music to aid my sleep as what i always do when I have insomnia. I was playing  JASON DERULO's WHAT IF and I was hearing the song differently. The song was playing in a slight fast forward mode. Got irritated so I turned off the music. After a while I fell asleep. 

The whole morning was ok, until afternoon came and i started to feel different again. I felt the "heavy" feeling again and so I was really not able to work well and just waited for my work to end and hurried back home and took some rest.

 

DAY 4 (Friday, May 10,2013)

Woke up feeling great and it continued until lunch and after that I was back to "feeling heavy" again and it stayed all throughout the afternoon until early evening.

 

DAY 5 (Saturday, May 11,2013)

Woke up great and I was feeling good the whole day. Asked mom to buy Nilagang Baka, this was the 1st time after I started my ARV that I was able to enjoy the food that I was eating. Never been happier.

 

DAY 6 (Sunday, May 12,2013)

Woke up great again although quite dizzy but is more tolerable and i was able to do some house chores without any problem. Stayed in the house all through out the day with frequent naps.

 

DAY 7 (Monday, May 13,2013)

Woke up around 12:30am and I was playing an instrumental music (violin). I was quite irritated by the sound because it doesn't sound right anymore. I was like playing a little fast again and it was not in tune (of course it's because of the Efavirenz again). So I stopped playing the music and went out of the room and slept at the folding bed in the Living Room. I did have a difficult time again to sleep but after an hour I fell asleep.

That's what I have been experiencing so far and it was a very stressful and hard week for me but I'm glad I made it. But this is just the first week and there's more to come. Hopefully this shall all pass and I can finally be able to adjust to my ARV.

I would like to thank everyone who sent me messages on my mobile, FB,Twitter... You have been given me great strength to overcome all these trials that I am undertaking. I Hope for a better week ahead.

 

 

Jake Positive. BE SAFE! +)

VACCINATION 101

A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe, its toxins or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as foreign, destroy it, and "remember" it, so that the immune system can more easily recognize and destroy any of these microorganisms that it later encounters.
Vaccines can be prophylactic (example: to prevent or ameliorate the effects of a future infection by any natural or "wild" pathogen), or therapeutic (e.g. vaccines against cancer are also being investigated).

Vaccines do not guarantee complete protection from a disease. Sometimes, this is because the host's immune system simply does not respond adequately or at all. This may be due to a lowered immunity in general (diabetes, steroid use, HIV infection, age) or because the host's immune system does not have a B cell capable of generating antibodies to that antigen.
Even if the host develops antibodies, the human immune system is not perfect and in any case the immune system might still not be able to defeat the infection immediately. In this case, the infection will be less severe and heal faster.


Who should get vaccinated?

The U.S. Centers for Disease Control have come out with updated vaccine guidelines for adults, especially women in the reproductive age group:

• Measles, Mumps, Rubella (MMR) vaccination is recommended for women of all ages.
• All adults should receive 2 doses of Varicella vaccine.
• The influenza vaccine is indicated in all adults and should be repeated yearly.

In the Philippines, the peak of the flu season is during the rainy months of June to September. The best time to get the flu vaccine is between March and June, although getting immunized in later months can still provide protection.

 
More vaccine guidelines

• In pregnant women, the only vaccines to be avoided are MMR, varicella and herpes zoster.
• Don’t get pregnant one month after receiving these vaccines.
• All adults between 19-64 years old should receive tetanus-diphtheria-pertussis (Tdap).  If pregnant, wait till after the 5th month.
• Pneumococcal vaccine should be given to all adults from age 65 and above. It may be given at a younger age if the adult has diabetes, asthma or a history of cigarette smoking.
• Hepatitis A and B vaccination should be repeated every 5 years.

With these new guidelines, it is hoped that an immunized populace will mean the eradication of preventable diseases that lead to many serious conditions.


Remember: an ounce of prevention is worth a pound of cure.

"PLEASE CONSULT YOUR DOCTOR BEFORE DOING IT"

Source: http://ph.she.yahoo.com/vaccinations-are-not-for-children-only.html
http://en.wikipedia.org/wiki/Vaccine


JaKe Positive. BE SAFE! +)

ARV ADHERENCE

 

Source: http://www.poz.com/index_focus.shtml

JaKe Positive. BE SAFE! +)

GUIDELINES FOR ANTIRETROVIRAL TREATMENT

 

 The decision to start a patient on ARV will be based on the clinical findings and/or CD4 level determination. The benefits, toxicity, adherence issues and costs of the treatment must be a component of counseling.

Criteria for Initiation of ARV

WHO Clinical Staging	CD4 Testing NOT AVAILABLE	CD4 Testing  AVAILABLE
STAGE 1 – ASYMPTOMATIC	DO NOT TREAT	TREAT if CD4 is BELOW 200 cells/mm3
STAGE 2 – MILD	DO NOT TREAT	TREAT if CD4 is BELOW 200 cells/mm3
STAGE 3 – ADVANCED	TREAT	Consider TREATMENT if CD4 is BELOW 350 cells/mm3 and initiate TREATMENT before CD4 falls below 200 cells/mm3
STAGE 4 – SEVERE	TREAT	TREAT irrespective of CD4 Count

 

---

WORLD HEALTH ORGANIZATION

CLINICAL STAGING OF HIV and AIDS

CLINICAL STAGE 1

Asymptomatic
Persistent Generalized Lymphadenopathy

CLINICAL STAGE 2

Unexplained moderate weight loss (under 10% of presumed or measured body weight)
Recurrent Upper Respiratory Tract Infections (Sinusitis, Tonsillitis, Otitis Media, Pharyngitis)

Herpes Zoster
Angular Cheilitis
Recurrent Oral Ulcerations
Papular Pruritic Eruptions
Seborrheic Dermatitis
Fungal Nail Infection

CLINICAL STAGE 3

Unexplained severe weight loss ( over 10% of presumed or measured body weight)
Unexplained Chronic Diarrhea for longer than one month
Unexplained Persistent Fever (intermittent or constant for longer than one month)
Persistent Oral Candidiasis
Oral Hairy Leukopakia
Pulmonary Tuberculosis (current)
Severe Bacterial Infections (e.g. Pneumonia, Empyema, Pyomyositis, Bone or Joint Infection, Meningitis, Bacteremia, Severe Pelvic Inflammatory Disease)
Acute Necrotizing Ulcerative Stomatitis, Gingivitis, Periodontitis
Unexplained Anemia (below 8g/dl), Neutropenia (below 0.5 x 10⁹ / 1) and/or Chronic Thrombocytopenia (below 50 x 10⁹ / 1)

CLINICAL STAGE 4

HIV Wasting Syndrome
Pneumocystis Pneumonia
Recurrent Bacterial Pneumonia
Chronic Herpes Simplex infection (Orolabial, Genital or Anorectal for more than one month’s duration or visceral at any site)
Esophageal Candidiasis (or Candidiasis of Trachea, Bronchi or Lungs)
Extrapulmonary Tuberculosis
Kaposi Sarcoma
Cytomegalovirus Infection (Retinitis or Infection of other organs)
Central Venous System Toxoplasmosis
HIV Encephalopathy
Extrapulmonary Cryptococci's incliding Meningitis
Disseminated Non-Tuberculosis Mycobacterial Infection
Progressive Multifocal Leukoencephalopathy
Chronic Cryptosporidiosis
Chronic Isosporiasis
Disseminated Mycosis (Coccidiomycosis or Histoplasmosis)
Recurrent Septicemia (including Non-Typhoidal Salmonella)
Lymphoma (Cerebral or B Cell Non-Hodgkin)
Invasive Cervical Carcinoma
Atypical Disseminated Leishmaniasis
Symptomatic HIV-Associated Neuropathy or HIV-Associated Cardiomyopathy

---

ANTIRETROVIRAL DRUGS: DOSES, INSTRUCTIONS, ADMINISTRATION, IMPORTANT ADVERSE REACTION

DRUG

DOSE

ADMINISTRATION

IMPORTANT ADVERSE REACTIONS

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTI’s)

Zidovudine (ZDV or AZT) 300mg Tablets	300mg every 12 hours	take without regard to meals	Anemia, Leukopenia, Lactic Acidosis (rare)
Lamivudine (3TC) 150mg Tablets	150mg every 12 hours or 300mg once daily	take without regard to meals	Well tolerated
Stavudine (d4T) 30mg Tablets	30mg every 12hours irrespective of body weight	take without regard to meals	Pancreatitis Lactic Acidosis Severe Hepatomegally with Steatosis Rapidly Progressing Ascending Neuromuscular Weakness
Didanosine (ddI) 200mg Entric Coated Capsules 250mg Entric Coated Capsules 400mg Entric Coated Capsules	Body weight: >60kg 400mg once daily with TDF: 250mg once daily Body weight: <60kg 250mg once daily with TDF: 200mg once daily	Must be taken on an empty stomach	Pancreatitis Lactic Acidosis

NUCLEOTIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTI)

Tenofovir (TDF) 300mg Tablets

300mg once daily

take without regard to meals

Nephrotoxicity

NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIs)

Efavirenz (EFV) 600mg Tablets	600mg once daily	Take on an empty stomach and before bedtime as severe dizziness is possible upon initiation of therapy that resolves or becomes tolerable after a few days	Rash Hepatitis
Nevirapine (NVP) 200mg Tablets	As severe hypersensitivity may develop during initiation, trial period should be done by giving 200mg once a day x 14days together with the full dose of NRTI. If there is no sign of hypersensitivity, then give full dose at 200my every 12hours.	Take without regard to meals Not recommended to be co-administered with Rifampicin.	STOP if any of these are observed: 1. Fever or Feverish Sensation 2. Flu-like Symptoms such as muscle or body pains 3. Disseminated Macular or Maculopapular or Urticarial rashes In case of mild skin rashes such as discreet papular or nodular rashes that are limited in number, without other signs, continue NVP and observe for any progression. Serious hepatic events have been reported among treatment-naïve with pre-Nevirapine CD4 counts >250 cells/mm3 or in treatment-naïve male patients with pre-Nevirapine CD4 counts >400 cells/mm3

PROTEASE INHIBITORS (PI’s)

Indinavir (IDV) 400mg Capsules	800mg every 12hours to be given with Ritonavir 100mg every 12hours	For RTV-boosted IDV take with or without food Take with plenty of water to avoid Nephrolithiasis. Not recommended to be co-administered with Rifampicin	Nephrolithiasis
Ritonavir (RTV) 100mg Capsules	100mg every 12hours to be given with Indinavir 800mg every 12hours or Sauinavir 1000mg every 12hours	For RTV-boosted IDV take with or without food For RTV-boosted SQV take within 2hours of a meal Not recommended to be co-administered with Rifampicin	Hepatitis Lipodystrophy
Lopinavir / Ritonavir (LPV/r) Lopinavir 200mg/Ritonavir 50mg Tablets	2 tablets every 12hours	Take without regard to meals Not recommended to be co-administered with Rifampicin	Gastro Intestinal Intolerance Lipodystrophy
Nelfinavir (NFV) 250mg Tablets 625mg Tablets	1250mg every 12hours 750mg every 8hours	Take with meal or snack Not recommended to be co-administered with Rifampicin	Gastro Intestinal Intolerance Lipodystrophy
Saquinavir (SQV) 500mg Tablets	1000mg every 12hours to be given with Ritonavir 100mg every 12hours	Take within two hours of a meal Not recommended to be co-administered with Rifampicin	Gastro Intestinal Intolerance Lipodystrophy

FIXED DRUGS COMBINATIONS

Lamivudine (3TC) + Stavudine (d4T) 3TC 150mg + d4T 30mg Tablets	1 Tablet every 12hours	Take without regard to meals	See Lamivudine and Stavudine above
Zidovudine (ZDV) + Lamivudine (3TC) ZDV 300mg + 3TC 150mg Tablets	1 Tablet every 12hours	Take without regard to meals	See Zidovudine and Lamivudine above
Zidovudine (ZDV) + Lamivudine (3TC) + Nevirapine (NVP) ZDV 300mg + 3TC 150mg + NVP 200mg Tablets	1 Tablet every 12hours	Take without regard to meals Not recommended to be co-administered with Rifampicin	See Zidovudine, Lamivudine and Nevirapine above
Emtricitabine (FTC) + Tenofovir (TDF) + Efavirenz (EFV) FTC 200mg + TDF 300mg + EFV 600mg Tablets	1 Tablet once daily	Take on an empty stomach and before bedtime	See Tenofovir and Efavirenz above. Emtricitabine – minimal toxicity, rare cases of lactic acidosis

---

IMPORTANCE OF ADHERENCE COUNSELING

HIV can develop resistance to ARV’s. The success of ARV Therapy largely depends on patient’s adherence to treatment. A 95% adherence rate is required to prevent the development of drug resistance.

LABORATORY TESTS PRIOR TO INITIATING ARV TREATMENT

Complete Blood Count (CBC)
Chest X-Ray, Sputum Acid Fast Bacilli (AFB) and Sputum Culture to rule out Active Tuberculosis
Pregnancy Test for Females of Reproductive Age
Baseline Urinalysis, Fasting Blood Sugar (FBS), Liver Function Tests, Creatinine, and Lipid Profile when indicated

MONITORING FOR ARV TOXICITY

For Zidovudine (AZT) + Lamivudine (3TC) + Efavirenz (EFV) / Nevirapine (NVP)

Complete Blood Count (CBC) – every month for the first 3 months and every 4-6 months thereafter
SGPT, SGOT, Alkaline Phosphatase, Amylase – after 1 month, after 6 months and every 12 months thereafter

For Tenofovir (TDF) + Lamivudine (3TC) + Efavirenz (EFV) / Nevirapine (NVP)

Creatinine and Urinalysis – Annually
SGPT, SGOT, Alkaline Phosphatase, Amylase – after 1 month, after 6 months and every 12 months thereafter

For Stavudine (d4T) + Lamivudine (3TC) + Efavirenz (EFV) / Nevirapine (NVP)

Complete Blood Count (CBC) – Annually
SGPT, SGOT, Alkaline Phosphatase, Amylase – after 1 month, after 6 months and every 12 months thereafter
Total Cholesterol, Triglyceride, Low Density Lipoprotein (LDL) – after 6 months and every 12 months thereafter

For Tenofovir (TDF) + Lamivudine (3TC) + Lopinavir / Ritonavir (LPV/r)

Creatinine and Urinalysis – Annually
Total Cholesterol, Triglyceride, Low Density Lipoprotein (LDL) – after 6 months and every 12 months thereafter
Fasting Blood Sugar (FBS) – after 6 months and every 12 months thereafter

For Zidovudine (AZT) + Lamivudine (3TC) + Lopinavir / Ritonavir (LPV/r)

Complete Blood Count (CBC) – after 1 month, after 6 months and avery 12 months thereafter
Total Cholesterol, Triglyceride, Low Density Lipoprotein (LDL) – after 6 months and every 12 months thereafter
Fasting Blood Sugar (FBS) – after 6 months and every 12 months thereafter

For Stavudine (d4T) + Lamivudine (3TC) + Lopinavir / Ritonavir (LPV/r)

Complete Blood Count (CBC) – Annually
SGPT, SGOT, Alkaline Phosphatase, Amylase – after 1 month, after 6 months and every 12 months thereafter
Total Cholesterol, Triglyceride, Low Density Lipoprotein (LDL) – after 6 months and every 12 months thereafter
Fasting Blood Sugar (FBS) – after 6 months and every 12 months thereafter

MONITORING RESPONSE TO TREATMENT

Trial of therapy for at least 6 to 12 months should be given before concluding that an ARV regimen is failing. For patients with good compliance to ART, clinical response is recommended to be used together with CD4 Count and Viral Load Determination (whenever available) to detect treatment failure.

CHANGE OF TREATMENT REGIMEN

Drug Toxicity and Side Effects

ARV Drugs are associated with side effects and long term toxicities. Although life threatening side effects had been reported, many side effects can be managed symptomatically. the ARV component causing toxicity should be identified and changed if necessary. The General Principle is that single-drug substitution because of toxicity should involve drugs belonging to the same ARV class.
It is also important to ask patients of intake of other medications because ARV’s may interact with these medications.

Treatment Failure

It is very important to regularly assess patients for treatment failure, determine the reasons for these and institute appropriate management immediately. If poor compliance is the cause of treatment failure then counseling for adherence must be intensified and the current regimen continued. Determination of CD4 Count should be performed after 3 months to reassess response to treatment.
Patients who are candidates for second-line ARV’s must be managed in close coordination with the Research Institute of Tropical Medicine or San Lazaro Hospital.

THESE INFORMATION IS JUST TO GIVE YOU AN IDEA ABOUT ARV TREATMENT. IT IS STILL BEST TO CONSULT YOUR DOCTOR ABOUT IT.

 JaKe Positive. BE SAFE! +)

Vitamins, Minerals, Herbal Supplements ??? Which to take???

VITAMINS & MINERALS

A well balanced diet will almost definitely meet all your vitamin and mineral needs, but many People Living with HIV also take a multivitamin and mineral tablet every day.

Vitamin and Mineral Deficiencies are seen in people with HIV who are unwell and have weak immune systems.

Some research has shown that taking nutritional supplements can slow HIV disease progression. However, other research failed to find any benefit.

HIGH DOSES OF VITAMINS & MINERALS

There is little evidence that taking large doses of vitamins and minerals have any benefit for People Living with HIV. Indeed, it is worth noting that large doses of some can cause very unpleasant side-effects and can even be dangerous.

Vitamin A

Doses above 9,000mcg (micrograms) in men and 7,500mcg in women may be harmful. Large amounts can cause liver and bone damage, vomiting and headache. If you are pregnant, or thinking about becoming pregnant, you should talk to your doctor before taking vitamin A as large doses can harm an unborn child, and high levels of the vitamin have been associated with increased viral load in breastmilk.

Vitamin C

Doses above 1000mg per day can cause kidney stones, and special care is needed if you are taking the protease inhibitor Indinavir (Crixivan) or Atazanavir (Reyataz) which can also cause kidney stones. It has also been shown that large doses of vitamin C can lower blood levels of Indinavir (Crixivan).

Vitamin E

Doses above 800mg a day may interfere with normal immune function. Special care is needed if you are taking anti-coagulants or if you have haemophilia.

Zinc

Doses above 75mg a day have been linked with copper deficiency, a shortage of immune system cells called neutrophils, and anaemia.

Selenium

Doses of more than 750 micrograms per day have been associated with immune suppression.

Vitamin B6

More than 2g a day can cause nerve damage, but doses as low as 50mg a day have been associated with peripheral neuropathy.

HERBAL SUPPLEMENTS

Herbal remedies are also widely used by People Living with HIV. However, some herbal remedies can interact with anti-HIV medication meaning that the amount of the HIV drug that gets into the blood is too low to effectively fight the virus leading to the emergence of drug-resistant HIV.

Because the use of herbal supplements is not studied as extensively as the use of prescription medications not all the potential interactions are known about.

Some of the most concerning interactions seen so far are:

AFRICAN POTATO

This herb is widely used in Africa by people with HIV, but test tube studies have shown that the body uses the same mechanism to process it as it does for HIV drugs, meaning that not enough anti-HIV drug may get into the blood.

GARLIC

Supplements of garlic have been shown to stop the body processing protease inhibitors and NNRTIs properly. A study involving HIV-negative volunteers taking a protease inhibitor found that a twice-daily garlic supplement lowered blood concentrations of the protease inhibitor. This finding is very concerning as garlic is often taken by people with high levels of fat in their blood, and high blood fats can be a side-effect of anti-HIV drugs. However, there is no evidence that garlic used for cooking interacts with HIV medicines.

ST. JOHN’S WORT

This popular herbal antidepressant has been shown to lower blood levels of Indinavir and the UK’s Medicines Control Agency has warned that it could affect blood levels of all protease inhibitors and the NNRTIs Efavirenz (Sustiva, also in the combination pillAtripla) and nevirapine (Viramune).

SUTHERLANDIA

A herb which is used in Africa for the treatment of people with HIV has been shown by laboratory studies to interact with anti-HIV drugs.

ADVICE

Before you take any vitamin, mineral or herbal supplement talk to your HIV doctor or specialist HIV pharmacist first. They will be able to tell you if there is a risk of an interaction with anti-HIV drugs.

A dietitian can analyse your diet and advise you on how to optimise your nutritional intake so you can meet your vitamin and mineral requirements through both foods and supplements.

Also remember, vitamins, minerals and herbals supplements can have side-effects, just like prescription medicines and you should never take more than the recommended dose.

Source: http://www.aidsmap.com/Vitamins-minerals-and-herbal-supplements/page/1045173/#item1045176


JaKe Positive. BE SAFE! +)