Advice about HIV viral load

[simon43]

My 18 year old Thai niece has HIV, confirmed by her doctor. I am visiting her for the first time in 3 years., and she contracted HIV about 1 year ago from a Thai guy. Her viral load now is 800. She is very thin and weak  Is it too late to help her? What medicine or intervention is possible? This is my young niece whom I love very much. I appreciate your honest advice.

[KhunLA]

'800' ???

She should probably see a doc, and get put on the appropriate meds.  I believe 'Truvada' or generic version of is the preferred one to start with.

 

Most locals use the Red Cross HIV/AIDS clinic at Krung Thep, due to anonymity and pricing.

[cleopatra2]

With HIV there are 2 indicators to monitor, viral load and white blood cell count . 

With a viral load of 800 ( untreated ,viral loads commonly could be in 100,000 ) I would not expect the white blood cell count to be low. Thus the description of weak and thin is suprising.

 

Common treatment in Thailand include Teno - EM with Edurant. The cost at government hospital around 1000 per month, I think for Thais this is covered under the 30bht scheme .

The individual should be registered and receiving regular appointments from a doctor to monitor the indicators.

 

[LivinLOS]

I have known multiple girls who sadly went through this.. 

A viral load of 800 is so low its barely present.. Viral loads of 10 20k are tolerated in healthy people even without retrovirals.. When the infection overwhelms the immune response then it spikes into the multi 10s of 1000s even 100s of 1000s and that is when CD4 drops off a cliff and and retrovirals are crucial. 

People also live long and healthy lives on retrovirals, and many go years, even decade plus without even needing retrovirals depending on thier own immune response. Hence the idea she has gone from infection to unsavable in a year seems wildly unlikely. 

I suspect either shes had it MUCH longer than your lead to understand or you have the numbers wildly wrong. 
 

[Kenny202]

Are you talking viral load or CD4? CD4 is their immunity level. I believe once the  CD4 dips beyond 200, the damage is pretty much done and it is then officially AIDs. On meds her viral load should be "undetectable". Still there but unmeasurable. Get her to a hospital immediately and get her on the meds. One pill a day these days (was 3) and they are usually given a 6 month supply. If the medication is taken immediately and without fail same time every day it is nothing more than a chronic illness these days. I assume it is for my ex as she ran straight back to the bars after we finished. Her viral load was 800 and doctor estimated she must have been infected 3-5 years. 800 isn't great but its not unsaveable. The hard part with Thais is ensuring they take the meds everyday, same time. They seem to get the idea that they feel ok now, no reason to take pills or go hospital anymore. I used to wait in the clinic with my one and the doctor was admonishing one after the other for not taking their meds. She knew as their viral load had decreased again. Another thing to note is stopping / starting the meds or stopping all together can make the person deteriorate faster than if they never had meds. Good luck with it. Sounds like she needs a good scare and does of tough love.

 

Im not sure if things are still the same but one of the problems were the small rural hospitals had a special area / office for HIV patients. In the very real chance someone you knew walked past you were exposed

 

 

Edited May 26, 2022 by Kenny202

[LivinLOS]

1 minute ago, Kenny202 said:

My first girl here was tested positive with a viral load of 1000. I believe one the VL dips beyond 200

likely you mean CD4.. Viral load rises over time as there is more virus in the blood.. 

CD4 in healthy people should be 800 - 1200.. once under 500 400 range then infected people start antivirals.. 

[Heng]

Good on you for trying to help.   Always sad to hear about something like this but at the same time a great reminder not to let one's guard down and doing something silly in one's private life safety wise.  

[Kenny202]

1 minute ago, Heng said:

Good on you for trying to help.   Always sad to hear about something like this but at the same time a great reminder not to let one's guard down and doing something silly in one's private life safety wise.  

I was living with a doctor in a rural area for nearly a year. She didn't discuss cases or much detail but the percentage of local people who had HIV was alarming. And that was only the people who were aware and had been tested. Luckily there is a mandatory HIV test in pregnant woman at 3 months.

 

I was with my girl on and off for 5 years and luckily I was negative. Straight after we broke up she ran straight back to Pattaya and in a bar. Has had a few boyfriends too who I assume dont know. And yes if someone is on their meds and disciplined very little chance of them passing it on. However would you trust this sort of person to have any sort of discipline? Their viral load can temporarily spike due to other illnesses also. In the case of the one I knew, she probably would have seen it as a business opportunity where she had no fear of bare backing for a premium charge. Be many more like her around too

[simon43]

Thanks for all your replies and advice.  To be honest, I was in a state of shock when I saw her.  My young female cook at my little hotel died of untreated Aids, and this is my niece who I have known since her birth, and for whom I was sponsor and 'guardian' at her school because her family had no money to send her to school.  I hadn't seen her 4 about 3 years, and I understand that she has been getting sicker for about 1 year now.  She has never worked in a bar etc, and has had only a few Thai boyfriends - so I guess she got infected from her BF (who is off the scene).

 

I say a viral load of 800 because I asked her mom if they had measured this and she said 800.  But the girl looks far too thin for that to be true.  White blood cell count maybe.

 

In any case, she has had absolutely no medication for HIV. Her local government hospital confirmed HIV diagnosis months ago, but only sold her an antifungal for her lungs - she actually only coughs a little bit. They never mentioned any other drugs because they knew that her family is too poor to buy them.

 

I guess my immediate practical problem is to get her to a doctor who will prescribe the required medication (I will cover the costs of course).  I think I need to ask her/her mom to visit her doctor again with a list of the drugs and see if he will agree to prescribe them.....

[Sheryl]

As others have suggested, 800 is unlikey to be her Viral Load, morel likely it is her CD4 count and, if so, it is still in  what is considered normal range (as would be expected if infected only a year ago).

 

Even if her CD4 were much lower, it is certainly not too late.

 

She can get treatment , free of charge, at government hospital (assuming she is a Thai citizen). She will have to stay on the medication for life, but with it, she can have a completely normal life in all other respects.

 

Since it does not sound like HIV is advanced enough to cause symptoms (unless there were a lot of 0's missing from that VL and she has been infected much more than a year), possibly the weakness and thinness is due to stress. Many Thais have little or no knowledge about HIV and do nto realize it can be controlled with medication.

 

Or - she may already be on treatment and suffering some side effects.  Which can be treated, and which she should discuss with the doctors providing her ART.

 

There are some support groups for HIV+ Thais, might be helpful if she would attend one.

 

Suggest she contact the AIDS Access Foundation Tel: 02 373 222 (10:00-20:00)

They provide free advice, information  and referrals

[Kenny202]

18 minutes ago, simon43 said:

Thanks for all your replies and advice.  To be honest, I was in a state of shock when I saw her.  My young female cook at my little hotel died of untreated Aids, and this is my niece who I have known since her birth, and for whom I was sponsor and 'guardian' at her school because her family had no money to send her to school.  I hadn't seen her 4 about 3 years, and I understand that she has been getting sicker for about 1 year now.  She has never worked in a bar etc, and has had only a few Thai boyfriends - so I guess she got infected from her BF (who is off the scene).

 

I say a viral load of 800 because I asked her mom if they had measured this and she said 800.  But the girl looks far too thin for that to be true.  White blood cell count maybe.

 

In any case, she has had absolutely no medication for HIV. Her local government hospital confirmed HIV diagnosis months ago, but only sold her an antifungal for her lungs - she actually only coughs a little bit. They never mentioned any other drugs because they knew that her family is too poor to buy them.

 

I guess my immediate practical problem is to get her to a doctor who will prescribe the required medication (I will cover the costs of course).  I think I need to ask her/her mom to visit her doctor again with a list of the drugs and see if he will agree to prescribe them.....

Bro, they dont have to buy drugs from a govt hospital, its all free. And I doubt very much they would have let her leave without medication. A few things about what you have been told do not sound 100%. If her cd4 was around 800 it would be unlikely she would be ill or wasting away. 

[Sheryl]

20 minutes ago, simon43 said:

Her local government hospital confirmed HIV diagnosis months ago, but only sold her an antifungal for her lungs - she actually only coughs a little bit. They never mentioned any other drugs because they knew that her family is too poor to buy them.

 

I guess my immediate practical problem is to get her to a doctor who will prescribe the required medication (I will cover the costs of course).  I think I need to ask her/her mom to visit her doctor again with a list of the drugs and see if he will agree to prescribe them.....

 This makes no sense at all. First of all, they would not have "sold" her antifungals if it was the government hospital where she is registered under the 30 baht scheme, it would have been free. Secondly, they would have referred her to a hospital with ART services (some of the community hospitals don't have this). And the ability of her family to buy drugs would not remotely enter into it, because ART is completely free.

 

You cannot get a doctor not trained in this to prescribe ART. She needs to go to the nearest government or NGO ART clinic. Where does she live?

[Lacessit]

17 minutes ago, simon43 said:

 

In any case, she has had absolutely no medication for HIV. Her local government hospital confirmed HIV diagnosis months ago, but only sold her an antifungal for her lungs - she actually only coughs a little bit. They never mentioned any other drugs because they knew that her family is too poor to buy them.

 

 

Your own statement should provide the clue to get  her to a good private hospital, where she will get appropriate drugs for treatment. IME government hospitals will use the cheapest generics they can find on the market, which is understandable given their patient load.

[Sheryl]

5 minutes ago, Lacessit said:

Your own statement should provide the clue to get  her to a good private hospital, where she will get appropriate drugs for treatment. IME government hospitals will use the cheapest generics they can find on the market, which is understandable given their patient load.

Thailand has a perfectly good system of ART treatment for people with HIV through the government system and there is nothing at all wrong with the quality of the drugs provided.

 

The story about what happened at the hospital is almost certainly not accurate. She would ave been referred to ART services (which might have been in the same hospital or elsewhere). OP need to dig further to figure out what really happened.

 

Likewise the "800 Viral load" is impossible.

 

 

 

 

 

[simon43]

8 minutes ago, Sheryl said:

Thailand has a perfectly good system of ART treatment for people with HIV through the government system and there is nothing at all wrong with the quality of the drugs provided.

 

The story about what happened at the hospital is almost certainly not accurate. She would ave been referred to ART services (which might have been in the same hospital or elsewhere). OP need to dig further to figure out what really happened.

 

Likewise the "800 Viral load" is impossible.

 

 

 

 

 

I now understand that the 800 refers to her white blood cell count.

 

She is not in the 30 baht system.  Surprising as it might sound, I know many poor Thais who are not in that system, possibly through ignorance.

 

She is not undergoing any form of treatment. The doctor at her local hospital gave her a few month's supply of the anti-fungal for her lungs and a 'multivitamin' drink (true - I saw it!).  He did not ask her to return for a follow-up appointment...

Edited May 26, 2022 by simon43

[Kenny202]

With all respect it sounds like u are being sold a pup. Everyone here is in the 30 baht system unless a vehicle or work accidents.The only way they cant get free medical is by not going to their allocated hospital. If she has moved to a location far away from her allocated hospital it can be changed pretty easily. Ive been through the process and they seem to make special efforts for HIV people.

[Sheryl]

13 minutes ago, simon43 said:

I now understand that the 800 refers to her white blood cell count.

 

She is not in the 30 baht system.  Surprising as it might sound, I know many poor Thais who are not in that system, possibly through ignorance.

NOT her white cell blood count, no one has a WBC count of 800. Possibly her CD4 count but if so, unless there was an extra 0 tacked on by mistake, she is not anywhere near suffering from AIDs, in fact her count is normal (still needs to start treatment as soon as possible to  keep it that way).

 

If she has even had a CD4 count done, she has already been seen by an HIV specialist/clinic. This is not something your average doctor or clinic does.

 

She IS covered under the "30 baht" (AKA "universal")  system. Nothing is required to enroll, just show her Thai ID card and register at the hospital which covers that location. Would be worth verifying what address is on her ID card/where she is listed in a tabian ban.

 

I have actually never met a single Thai -- and I know plenty of poor ones -- who were not well aware of the system. What I have encountered are :

 

(1) people whose tabian ban listing is in a different province from where they live and do not know how to resolve that (answer if usually to get a new tabian ban listing but in some locations hospitals will accept other proof of residence)

 

(2) people who tell a foreigner that they are not covered (even though they are) in hopes of eliciting financial support. This happens a lot. Reasons vary, from outright scams to just wanting to get private treatment for other reasons (e.g. being uncomfortable being seen going to HIV clinic at a local hospital for fear of stigma).

 

 

[Sheryl]

8 minutes ago, Kenny202 said:

With all respect it sounds like u are being sold a pup. Everyone here is in the 30 baht system unless a vehicle or work accidents.The only way they cant get free medical is by not going to their allocated hospital. If she has moved to a location far away from her allocated hospital it can be changed pretty easily. Ive been through the process and they seem to make special efforts for HIV people.

Absolutely correct, OP is not being told the true story. By these people and any other Thais who told him they did not know about the system.

 

I would add though that with HIV, people are often reluctant to use their local health service. Not because it does not provide the needed care, not because it is not free, not because they don't about it, but for fear of their HIV status getting known in the community. This is so common that there may be a way around it to get treatment at a different location (of course, she'd have to travel to it), the AIDS Access foundation could advise on this as I am not sure.

[simon43]

Sheryl, sorry because I missed your previous message.  I have asked her and her mom if she is receiving any ongoing treatment, or if she has been referred to a specialist.  The answer is no. She truly looks like a concentration camp victim and I personally doubt if she can pull through.  It's possible that the doctor considered her beyond help, and sent her home to die, but then the 800 value makes no sense. Seeing the physical state of her body, I am surprised that she is still alive ????

 

I will ask her/her mom again why she is not receiving treatment and free medication ????

[cleopatra2]

1 hour ago, simon43 said:

Thanks for all your replies and advice.  To be honest, I was in a state of shock when I saw her.  My young female cook at my little hotel died of untreated Aids, and this is my niece who I have known since her birth, and for whom I was sponsor and 'guardian' at her school because her family had no money to send her to school.  I hadn't seen her 4 about 3 years, and I understand that she has been getting sicker for about 1 year now.  She has never worked in a bar etc, and has had only a few Thai boyfriends - so I guess she got infected from her BF (who is off the scene).

 

I say a viral load of 800 because I asked her mom if they had measured this and she said 800.  But the girl looks far too thin for that to be true.  White blood cell count maybe.

 

In any case, she has had absolutely no medication for HIV. Her local government hospital confirmed HIV diagnosis months ago, but only sold her an antifungal for her lungs - she actually only coughs a little bit. They never mentioned any other drugs because they knew that her family is too poor to buy them.

 

I guess my immediate practical problem is to get her to a doctor who will prescribe the required medication (I will cover the costs of course).  I think I need to ask her/her mom to visit her doctor again with a list of the drugs and see if he will agree to prescribe them.....

There is something lost in translation . The symptoms described do not reflect the figure of 800 quoted , either as CD4 or viral load . 

The other issue is the hospital have to send the blood samples to a lab in order to obtain the measurements, which take approx. 2 weeks for results  .

In order for the parents to quote a figure they must have returned to the hospital and seen a doctor.

 

When you asked I suspect that the parents plucked a number from their imagination 

 

 

 

 

[cleopatra2]

Just now, cleopatra2 said:

There is something lost in translation . The symptoms described do not reflect the figure of 800 quoted , either as CD4 or viral load . 

The other issue is the hospital have to send the blood samples to a lab in order to obtain the measurements, which take approx. 2 weeks for results  .

In order for the parents to quote a figure they must have returned to the hospital and seen a doctor.

 

When you asked I suspect that the parents plucked a number from their imagination and no blood tests have been carried out.

 

 

 

 

 

[simon43]

9 minutes ago, cleopatra2 said:

There is something lost in translation . The symptoms described do not reflect the figure of 800 quoted , either as CD4 or viral load . 

The other issue is the hospital have to send the blood samples to a lab in order to obtain the measurements, which take approx. 2 weeks for results  .

In order for the parents to quote a figure they must have returned to the hospital and seen a doctor.

 

When you asked I suspect that the parents plucked a number from their imagination 

 

 

 

 

I don't think so.  She must have visited the hospital on a number of occasions previously, since she says that she has been sick for about 1 year. I saw and read the anti-fungal medication that she was given for her cough.  Anyway, it's not worth guessing about this - her mom will chat by phone with a specialist doctor in Pattaya and then the picture may become a little clearer.

[Kenny202]

8 minutes ago, simon43 said:

I don't think so.  She must have visited the hospital on a number of occasions previously, since she says that she has been sick for about 1 year. I saw and read the anti-fungal medication that she was given for her cough.  Anyway, it's not worth guessing about this - her mom will chat by phone with a specialist doctor in Pattaya and then the picture may become a little clearer.

Sick for a year or diagnosed positive for a year? Big difference...and maybe her CD4 was 800 a year or 2 ago. If her condition is that bad it sounds like she is already at the AID's stage. But even so, and correct me if I'm wrong Sheryll even at the age stage they should be on meds that will prolong things and ease the symptoms. Sounds very similar to the young guy across the road in the village that got HIV and went undiagnosed. Died last year at home, looked like a skeleton. I know because I found out he was seeing my GF when I was back home. So he gave it to her or she gave it to him not sure, but after she was diagnosed my GF never told him. Nor the hundreds of customers and boyfriends she's likely had since

Edited May 26, 2022 by Kenny202

[cleopatra2]

43 minutes ago, simon43 said:

Sheryl, sorry because I missed your previous message.  I have asked her and her mom if she is receiving any ongoing treatment, or if she has been referred to a specialist.  The answer is no. She truly looks like a concentration camp victim and I personally doubt if she can pull through.  It's possible that the doctor considered her beyond help, and sent her home to die, but then the 800 value makes no sense. Seeing the physical state of her body, I am surprised that she is still alive ????

 

I will ask her/her mom again why she is not receiving treatment and free medication ????

Do you consider her condition a life and death situation . If so a visit to emergency is required.

[cleopatra2]

11 minutes ago, Kenny202 said:

Sick for a year or diagnosed positive for a year? Big difference...and maybe her CD4 was 800 a year or 2 ago. If her condition is that bad it sounds like she is already at the AID's stage. But even so, and correct me if I'm wrong Sheryll even at the age stage they should be on meds that will prolong things and ease the symptoms. Sounds very similar to the young guy across the road in the village that got HIV and went undiagnosed. Died last year at home, looked like a skeleton. I know because I found out he was seeing my GF when I was back home. So he gave it to her or she gave it to him not sure, but after she was diagnosed my GF never told him. Nor the hundreds of customers and boyfriends she's likely had since

Even at the Aids stage  the situation can be reversed to HIV on condition that there is no treatment virological failure and other opportunistic diseases are treated.

[Kenny202]

1 minute ago, cleopatra2 said:

Even at the Aids stage  the situation can be reversed to HIV on condition that there is no treatment virological failure and other opportunistic diseases are treated.

I don't believe that is the case

[cleopatra2]

18 minutes ago, Kenny202 said:

I don't believe that is the case

Under monotherapies the Aids stage was unlikely to be reversed due to the virus obtaining immunity.

However with the introduction of ART the ability of the virus to replicate is stopped, Thus as the virus load decreases due to inability replicae the non infected CD4  increases.

 

Edited May 26, 2022 by cleopatra2

[Kenny202]

2 minutes ago, cleopatra2 said:

Under monotherapies the Aids stage was unlikely to be reversed due to the virus obtaining immunity.

However with the introduction of ART the ability of the virus to replicate is stopped, Thus as the virus load decreases to inability due non replication the non infected CD4  increases.

 

Doctor told me only 2 years ago once CD4 drops below 200 (AIDs) the damage is already done and the immune system can no longer repair or defend itself. Only a matter of time then. Sherryl will know

[cleopatra2]

12 minutes ago, Kenny202 said:

Doctor told me only 2 years ago once CD4 drops below 200 (AIDs) the damage is already done and the immune system can no longer repair or defend itself. Only a matter of time then. Sherryl will know

The doctor is correct on the classification. CD4 less than 200 or presence of opportunistic diseases. However to suggest that this is near to death is incorrect. 

The term Aids originated when only monotherapies was in use and used to describe the situation close to death. With the advent of ART this is no longer the case.

I know of many people who had a cd4 count less than 50 when diagnosed with HIV, clinically Aids. Following a n ART regime their cd4 is now above 800 and VL less than 20.

The majority of newly diagnosed HIV patients are clinically at the Aids stage

[Kenny202]

1 hour ago, cleopatra2 said:

The doctor is correct on the classification. CD4 less than 200 or presence of opportunistic diseases. However to suggest that this is near to death is incorrect. 

The term Aids originated when only monotherapies was in use and used to describe the situation close to death. With the advent of ART this is no longer the case.

I know of many people who had a cd4 count less than 50 when diagnosed with HIV, clinically Aids. Following a n ART regime their cd4 is now above 800 and VL less than 20.

The majority of newly diagnosed HIV patients are clinically at the Aids stage

I am sorry, I don't think you know what you are talking about. You are making ridiculous statements, many of which look like they have been copied and pasted from somewhere else. ART drugs have been around for 30 years.

 

Majority of newly diagnosed patients clinically at the AID's stage? That just isn't true is it?

 

You know many people who had a CD count of less than 50 when diagnosed? How? you would have to be a doctor or a nurse working in a HIV clinic.

 

2 weeks for a viral load / CD4 test result? Wrong again. Next day at the latest.

 

Your comment of people on ART treatment having a viral load less than 20 does also not make sense. Technically right but generally people on ART zero viral load after 2 to three months

Edited May 26, 2022 by Kenny202