Advice about HIV viral load

[LivinLOS]

4 hours ago, simon43 said:

They never mentioned any other drugs because they knew that her family is too poor to buy them.

Some of the more budget anti virals are available on thai healthcare.. 

[Kenny202]

Just now, LivinLOS said:

Some of the more budget anti virals are available on thai healthcare.. 

What???? Budget anti virals?

 

[LivinLOS]

11 minutes ago, Kenny202 said:

What???? Budget anti virals?

 

yes theres a whole range of generics and then theres the 'something access' program from gilead which sells limited amounts of antivirals to developing world countries at generic prcing.. So you have full price, subsidized price and copies.. 

Red cross clinic in bangkok has a whole menu for all kinds of budgets.. Back before the Thai healthcare covered this I assisted multiple Phuket girls to establish contact and med supply that way as it was much cheaper than the private hospitals (and then the gov hospitals were with no or worse cover).. Even atripla (now no longer here as a 1 a day, its now a strocin truvada combo) is only in the mid 2k a month and atripla is western first line defense IIRC, no short changing at all. 

I dont believe the Thai 30b system offers atripla but it may do these days ?? Years ago when this happened what was possible on the thai systems was not the best, it was the 'budget anti virals' as I said. 

 

Edited May 26, 2022 by LivinLOS

[orchis]

Just now, LivinLOS said:

I dont believe the Thai 30b system offers atripla but it may do these days

it does. even outside the 30 thb scheme medication can cost as little as 450 thb per month, but most patient are on 30 thb scheme or get medication for free. (this all based on first hand information from patients).

[orchis]

Just now, Sheryl said:

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).

if she is sick as described, could the VL rather be 800K (800,000)?
this is not uncommon at first diagnosis of more advanced cases; I have known people with initial VL from 500,000 to 2,000,000.

[LivinLOS]

6 minutes ago, orchis said:

it does. even outside the 30 thb scheme medication can cost as little as 450 thb per month, but most patient are on 30 thb scheme or get medication for free. (this all based on first hand information from patients).

ATRIPLA... I dont believe the Thai healthcare offers ATRIPLA.. 

In fact, you can not obtain atripla one a day in Thailand at all, since the last few years, but the strocin + truvada combo is exactly the same medications only a 2 a day not a 1 a day, but again, I am 99% sure that strocin truvada is not covered here under the national health schemes (it wasnt recently for sure) they have other cheaper varieties for the Thai systems.. The Red Cross has it for something mid 2000 a month and thats a standard first line regimen in the west. 

Edited May 26, 2022 by LivinLOS

[thaitom]

1 hour ago, Kenny202 said:

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

 

2 hours 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

This is a 100% correct statement...    And yes I do know a person that had a CD4 of less than 50 with opportunistic infections  , with treatment it has been well above 700 for well over 17 years now. 

[Sheryl]

Just now, orchis said:

if she is sick as described, could the VL rather be 800K (800,000)?
this is not uncommon at first diagnosis of more advanced cases; I have known people with initial VL from 500,000 to 2,000,000.

 

Maybe. But it does not sound like she would have had a VL done as she seems not to have gone any further than small community hospital.

 

From further offline discussions with OP she seems to be in advanced stages of full blown AIDs.

[LivinLOS]

Just now, thaitom said:

 

This is a 100% correct statement...    And yes I do know a person that had a CD4 of less than 50 with opportunistic infections  , with treatment it has been well above 700 for well over 17 years now. 

I also know someone who was down in the sub 80 range on diagnosis way back around 04 05 and shes still doing well (and has had kids !!) apparently on social media. 

[LivinLOS]

1 minute ago, Sheryl said:

From further offline discussions with OP she seems to be in advanced stages of full blown AIDs.

Then all this speculation is useless until Simon actually establishes whats what, too many elements dont make sense (1 year with it in an 18 y/o, etc) .. Get her to a proper hospital, get the bloodwork done, get her on antivirals immediately.. The rest is just guesswork and wasting time. 

Its not even very expensive. 

[Kenny202]

2 minutes ago, LivinLOS said:

I also know someone who was down in the sub 80 range on diagnosis way back around 04 05 and shes still doing well (and has had kids !!) apparently on social media. 

I didn't say it's not possible....He said he knew MANY. I strongly doubt that unless someone is working in HIV healthcare every day

[LivinLOS]

2 minutes ago, Kenny202 said:

I didn't say it's not possible....He said he knew MANY. I strongly doubt that unless someone is working in HIV healthcare every day

if you live around places like Patong beach and Pattaya.. and you are actually friends with the girls socially.. its sadly scary common.. 

I could count well into double digits who were diagnosed.. a handful dead.. Including 2 or 3 really pretty good friends.. But also many who recovered, took the meds, and went on to live normal lives. 

[Sheryl]

3 hours 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.

 

Even at advanced stage, should be started on ART which if they are able to tolerate it, will bring them eventually back to full health. They also need to be treated for any and all opportunistic infections, which in  SE Asia frequently includes active TB.

 

The problem is that very emaciated, weak people may be unable to tolerate the necessary medications. But no way to know without trying. I have now seen pictures and gotten more deatailso n her condition, she clearly has full blown AIDs

 

Thee is a lot missing from this story - no way has she only been infected or only year, no way is her VL or CD4 800, no way was she diagnosed and not referred to an  ART site for treatment (though the site may well have been far from her village). But what is important now is to get her on treatment as soon as possible.

[Sheryl]

3 hours 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

Completely untrue.

 

The prognosis is worse of ocurse, but if the patient is able to tolerate ART and complies with it, and if any coexsiting opportunistic infections are treated, full recover is possible.

 

Many, many people have recovered from CD4 counts well under 200. In fact, it wasn't that long ago when treatment was only given after CD4 dipped below 250.

 

But of course, prognosis is better if treatment starts before that point.

 

And once very ill, ut may be hard toi tolerate the tretaments. But only one way to find out.

[msbkk]

quote: atripla is western first line defense IIRC, no short changing at all. 

Atripla was removed as first line treatment in the West some time ago, in the US 7 years ago already. There are better and newer medications available with less side effects.

Edited May 26, 2022 by msbkk

[orchis]

Just now, thaitom said:

 

This is a 100% correct statement...    And yes I do know a person that had a CD4 of less than 50 with opportunistic infections  , with treatment it has been well above 700 for well over 17 years now. 

I know someone who has been living with hiv and on meds since 1997, that is 25 years, without major health issues, cd4's in the 1000 range. Initially cd4's were 220 but he totally went back to health.

Edited May 26, 2022 by orchis

[orchis]

Just now, 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.

That's correct.

[Onerak]

@sheryl is much knowledgeable here about health related issues. I know a Thai girl who contracted HIV. HIV treatment in Thailand is pretty good. The person must go to a hospital and get thoroughly checked. All medications are not suitable for every person. She should never take medications from random forum posting. A doctors will evaluate her situations and recommend medications and monitor her other conditions. It also requires monitoring kidney and lever because all medications have adverse effects on other organs. Doctors may change medications a few times to find optimal doses for medications suitable for her and she must stay on that medications for life. Initially these medications will have all kinds of side effects. She should discuss all her conditions with her doctors. The person I knew is doing fine now after  7 years. Now her CD4 has gone up more than 1000. This after a few adjustments to her medications and twice hospitalized for adverse issues. All treatments are free in Thailand including hospitalizations for adverse effect. She should go to her Provincial hospitals. The girl I knew went to Banglamung hospitals. 

Edited May 26, 2022 by Onerak

[Lacessit]

This thread is very sad, because it seems the OP's niece has slipped through the cracks of the Thai public health system somehow.

[scubascuba3]

3 minutes ago, Lacessit said:

This thread is very sad, because it seems the OP's niece has slipped through the cracks of the Thai public health system somehow.

Also how has she had it for so many years when she is 18, a can of worms

[Lacessit]

1 minute ago, scubascuba3 said:

Also how has she had it for so many years when she is 18, a can of worms

Agree, I have to wonder about the doctor she went to as well.

[Kenny202]

5 minutes ago, Lacessit said:

This thread is very sad, because it seems the OP's niece has slipped through the cracks of the Thai public health system somehow.

I am guessing she was probably her own worst enemy. Like I said have say in HIV clinic areas at the hospital and seen the admitting doctor admonishing one after the other for not taking their meds. Thais tend to worry about stuff after it's too late

[GarryP]

1 hour ago, LivinLOS said:

ATRIPLA... I dont believe the Thai healthcare offers ATRIPLA.. 

In fact, you can not obtain atripla one a day in Thailand at all, since the last few years, but the strocin + truvada combo is exactly the same medications only a 2 a day not a 1 a day, but again, I am 99% sure that strocin truvada is not covered here under the national health schemes (it wasnt recently for sure) they have other cheaper varieties for the Thai systems.. The Red Cross has it for something mid 2000 a month and thats a standard first line regimen in the west. 

Item 6 of 5.3.2 of Antiretrovirals as listed on the Thailand List of Essential Medicines is the combo Tenofovir disoproxil fumarate + Emtricitabine + Efavirenz tab (300 + 200 + 600 mg). I assume that is a single tablet as it is listed as a single item. It is my understanding that any medicine listed on such list is covered by the universal healthcare scheme.   

[orchis]

Just now, LivinLOS said:

ATRIPLA... I dont believe the Thai healthcare offers ATRIPLA.. 

In fact, you can not obtain atripla one a day in Thailand at all, since the last few years, but the strocin + truvada combo is exactly the same medications only a 2 a day not a 1 a day, but again, I am 99% sure that strocin truvada is not covered here under the national health schemes (it wasnt recently for sure) they have other cheaper varieties for the Thai systems.. The Red Cross has it for something mid 2000 a month and thats a standard first line regimen in the west. 

In Thailand there is Teevir, a one pill generic equivalent of Atripla (Tenofovir Disoproxil Fumarate/Emtricitabine/Efavirenz), which is free or under the 30 thb scheme. I know a patient who gets it free from Nakornping, athe public hospital in Mae Rim.
btw Atripla has not been the first line treatment regimen in the west for a while now.
 

[Kenny202]

5 hours ago, simon43 said:

 

Girl I knew started meds about 5 years ago. Back then was 3 pills every night. Like she was stoned after taking them. About 3 years back they put her on a single pill. Good also as it is hard for someone who's family doesnt know to be discreet with a 6 month supply of 3 bottles of pills and another reason for them to quit the meds.

[simon43]

Thanks to Sheryl's good advice, her mom has contacted the provincial hospital and is trying to get her admitted.  Yes, she is only 18 years old, but I know that she was 'playing around' with Thai teen boys in her early teens.  It does seem to be a case of ignorance or denial.  I haven't seen her for quite a few years, so was unaware of her physical condition.  Anyway, let's see if she can get admitted to the hospital and some tests done/medications given.

[Adumbration]

7 hours 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.

Like me, Simon was in Thailand a long time (and sounds like he is back for a visit).  He also speak good Thai.  He might not have been provided with correct information, but I can assure you that he is not being sold a pup.

[LivinLOS]

13 hours ago, GarryP said:

Item 6 of 5.3.2 of Antiretrovirals as listed on the Thailand List of Essential Medicines is the combo Tenofovir disoproxil fumarate + Emtricitabine + Efavirenz tab (300 + 200 + 600 mg). I assume that is a single tablet as it is listed as a single item. It is my understanding that any medicine listed on such list is covered by the universal healthcare scheme.   

I know a Thai who used to have one a day atripla.. A couple of years ago they became unable to obtain it from thier regular (expensive higher end) private hospital and that hospital told them it is no longer offered for import to Thailand. They were offered strocin and truvada and now obtain that combo from the red cross clinic in Bangkok (who also used to have atripla but say the same as the hospital.. That is it no longer available here) the combo makes almost no difference other than branding 2 a day one time or 1 a day one time. They say that they are not offered that exact combination medicine on the Thai healthcare system, I am unsure what they were offered, only they tried, failed, and spend thier own money to obtain it. As this is a family friend and as this is a private subject its not something I questioned too deeply. 

Its my understanding (and I could be wrong) that all the available options that exist here are accessible via the Thai Red Cross clinic. As you can see ATRIPLA is no longer on the list https://en.trcarc.org/medical-service/ I had understood that this was something to do with Thailands import or licensing but as I googled it perhaps it is no longer an authorized regimen (which was news to me) https://www.ema.europa.eu/en/documents/overview/atripla-epar-medicine-overview_en.pdf

Edited May 27, 2022 by LivinLOS

[LivinLOS]

13 hours ago, orchis said:

In Thailand there is Teevir, a one pill generic equivalent of Atripla (Tenofovir Disoproxil Fumarate/Emtricitabine/Efavirenz), which is free or under the 30 thb scheme. I know a patient who gets it free from Nakornping, athe public hospital in Mae Rim.
btw Atripla has not been the first line treatment regimen in the west for a while now.
 

Interesting.. I see the option via the RC also.. 

[Sheryl]

8 minutes ago, LivinLOS said:

I know a Thai who used to have one a day atripla.. A couple of years ago they became unable to obtain it from thier regular (expensive higher end) private hospital and that hospital told them it is no longer offered for import to Thailand. They were offered strocin and truvada and now obtain that combo from the red cross clinic in Bangkok (who also used to have atripla but say the same as the hospital.. That is it no longer available here) the combo makes almost no difference other than branding 2 a day one time or 1 a day one time. They are not offered that exact combination medicine on the Thai healthcare system, I am unsure what they were offered, only they tried, failed, and spend thier own money to obtain it. As this is a family friend and as this is a private subject its not something I questioned too deeply. 

Its my understanding (and I could be wrong) that all the available options that exist here are accessible via the Thai Red Cross clinic. As you can see ATRIPLA is no longer on the list https://en.trcarc.org/medical-service/ I had understood that this was something to do with Thailands import or licensing but as I googled it perhaps it is no longer an authorized regimen (which was news to me) https://www.ema.europa.eu/en/documents/overview/atripla-epar-medicine-overview_en.pdf

Atripla is a brand name for an expensive import made by Gilead. It is a combination of the drugs Efavirenz, emitricitabine and tenofovir.

 

The exact same thing is available in  locally made generic equivalent, brand names GPO-Vir-T and Teevir. Once these  become available, Atriple brand went off market here.  Has nothing to do with any change of regimen, rather is the result of the Thai government's use of "compulsory licensing" to manufacture local generics of patent drugs when deemed a public health necessity.

 

There are many approved regimens for ART here and the selection is based on a number of patient specific factors. It is complex and needs specialized training and tests to administer this treatment, which is why it cannot be prescribed by just any doctor, and why small community hospitals, unless located in a place with high enough HIV prevalence to make it cost effective to have their own ART clinic, will usually have to refer to provincial hospital.