My Friend Just Found Out He's Hiv+. What Can I Do To Help?

[theufo8mycow]

Hi, thanks for reading.

Someone extremely special and close to me has just found out that he's HIV positive.

He's in shock right now. He's feeling very lonely, hurt, confused, angry, regret, and extremely scared. I'm feeling the same too. I was even thinking about telling him to do the test again because I am still in disbelief. But getting the same results the second time might be devastating. He hasn't told anyone except me. Unfortunately I am not based in Bangkok and he is in Bangkok alone. Although I know he's a smart, strong and independent person, I question his strength to be able to handle this mentally. He's looking up to me for company and consolation, but I'm also at loss to what to do. No matter how much I try to comfort him it doesn't work because I feel the same as he.

I want to help him as much as I can.

I'd like to know which hospital in Bangkok is reputable in counselling and treatment. UNESCO mentioned these hospitals: Sukhumvit Hospital, BNH Hospital, Bumrungrad Hospital and Samitivej Hospital. There's also another hospital called Vibhavadi Hospital? I read the forums whereby the following doctors are recommended:

Dr Mattana Hanavich at Bumrungrad Hospital

Dr Mondej Sookpranee at Bumrungrad Hospital

Dr Asda Vibhagool at Rathibodi Hospital

Dr Paitoon Boonma in Bangkok General Hospital

Dr Dr Phillipe Seur in Pattaya

Any other recommendations?

Does counselling come with treatment?

Should my friend and I talk to a counsellor first or should we see a doctor right away?

Are there any support groups to help HIV+ people for moral support, to get by?

I know that some of these hospitals are private, which can be pricey. I'm not sure whether he can afford it, even though he has an ok paying job. I'm unsure if it's enough to cover the expensive medication. I am also unsure if he has any insurance.

I did read the prices of the treatment in AIDS treatnment in LOS post. But is it safe to buy the cheaper medication at the pharmacies that are not from the hospital, or are these unreliable?

I'd hear out any opinions about this. Any help and replies are much appreciated. Thank you in advance.

ufo.

Edited April 12, 2009 by theufo8mycow

[chakatee]

Luckily for your friend you are going a little bit too fast here.

The fact that he is found to be Anti-HIV positive (having antibodies against HIV) doesn't mean he's got AIDS yet and therefore doesn't need AIDS-treatment yet.

First thing to do is start having his CD4 (how much resistance does he still have) and viral load (how much of the virus is to be found in his blood) monitored. As long as these 2 values stay within a good range (and that can be years, especially if he tries to live a healthy life style), there is no AIDS and therefore no treatment.

Once he is getting in the 'danger zone' (lower resistance and higher amount of virus in his blood), his doctor will decide with him to start some treatment. But also that is getting more and more effective so that, depending his age, there is an increasing chance that he will die with AIDS in stead of from AIDS.

Not wanting to underestimate the disease either though. The treatment, once it get at that stage, needs to be followed strictly, might have nasty side effects, is rather costly, ...

Many will come here to say 'som nam naa', I think 'good luck' for your friend seems more appropriate at this time.

[TonySoprano]

how does he think he got it?

[PeaceBlondie]

None of our business how he got it. He needs to confirm that he has it, and how advanced it is.

[theufo8mycow]

Thanks for your replies everyone.

My friend did a blood test at Vibhavadi Hospital. 1-2 hrs later, the results were HIV+.

He has not done the CD4 and viral load test yet, which I will advise him to do soon.

My friend and I plan to see Dr Mattana Hanavich at Bumrungrad Hospital this week.

Hope she's free and can advise what to do next.

This might be a stupid question but what are the chances if the HIV+ test is wrong, maybe because it got mixed up with someone else's? Is it worth doing the test again?

ufo

[chakatee]

The chance on a false positive due to mixing up with someone elses blood is as good as non-existing i.m.o.

The chance on a false positive Elisa in general is 4 - 7 on 10,000. Always need to be confirmed by Western Blot to reduce chance for false positive to 1 on 250,000.

So first things to do:

- Confirm with Western Blot

- If confirmed, have CD4 count and Viral load blood tests, to be repeated upon your doctor's advice

[yumidesign]

Thanks for your replies everyone.

My friend did a blood test at Vibhavadi Hospital. 1-2 hrs later, the results were HIV+.

He has not done the CD4 and viral load test yet, which I will advise him to do soon.

My friend and I plan to see Dr Mattana Hanavich at Bumrungrad Hospital this week.

Hope she's free and can advise what to do next.

This might be a stupid question but what are the chances if the HIV+ test is wrong, maybe because it got mixed up with someone else's? Is it worth doing the test again?

ufo

personally i would suggest he have the test done again. This is Thailand

research the internet and become an expert...... start with Mayo clinic

[Sheryl]

This might be a stupid question but what are the chances if the HIV+ test is wrong, maybe because it got mixed up with someone else's? Is it worth doing the test again?

ufo

The chances of a false positive are extremely small and they will have, as a matter of routine, rechecked it with Western Blot.

In any case your friend needs a Viral Load done. If by some very rare chance the antibody test was a flase positive, the VL will nto show any virus present.

So I recommend proceeding with VL and CD4 count.

Also refer your friend to this website, a self-help site run by people who are HIV+, has a number of forums/links and info just for peopkle recently fiagnosed:

www.thebody.com

Good luck

[PattayaParent]

Ask what the parameters of the test were.

I'm going back maybe 10 years now but I remember reading that in Thailand if they find 4 anti HIV antibodies they will declare HIV positive whereas in the West it's only if 6 anti HIV antibodies are present.

BUT do the research / ask the questions yourself rather than rely on replies on a forum unless it's from a qualified HIV doctor.

[theufo8mycow]

Thanks for all the replies everyone.

I'd just like to update everyone on what has happened so far in case you're curious and perhaps my info can help anyone there too.

My friend went to re-test his HIV status. He's confirmed HIV+.

He also did some examination. He has some symptoms - swollen glands.

His CD4 cell count is 331, CD4 % 20.3%. His viral load is 13,800.00.

With these results, the doctor advised to do a:

A) Hepatitis Ag and Ab test. He's clear but not immunized.

Repeat his CD4 test in a months' time.

C) Do a HIV Genotype test.

D) Urine exam for syphillis.

When he wanted to do the geno test and the Hep immunization, the nurse & doctor told him that he is currently not in a good state of mind and body because he's in still a state of shock and being in this state of mind and body would affect the results of the tests that he was supposed to do. He had no motivation, no appetite, crying all day and night and thinking about death, avoiding all friends and being in a state of panic thinking about medication straightaway. What's worse, he may lose his job due to the current recession.

Also the doctor said that he needs to do a series of CD4 tests to check whether he really needs to take medication or not. There's no point to take medication too early or else it will not be effective if it's not required.

I told him that needs to try very hard to be strong and think positive, which I'm sure is very hard to do in his situation. After days of comforting him, when I thought he was ready, I told him straight-up and said that nobody lives forever, and you should live the life you want to live and don't let this stop from doing whatever you're doing. With medication nowadays, people with HIV+ can possibly live longer if they maintain a healthy lifestyle.

He has hope and moving on slowly. He has started to eat well again, going back to the gym like his normal schedule, and smoking less to nil.

I've been giving him moral support and slowly day by day he's facing this. Hopefully in a month's time, his mood and state of mind is ready for these tests.

Edited April 28, 2009 by theufo8mycow

[mommysboy]

"With medication nowadays, people with HIV+ can possibly live longer if they maintain a healthy lifestyle."

I think this is a major point and is perhaps even understated. It's clearly been a terrific shock but he'll recover emotionally too.

IMHO I find the AIDS paradigm a bit unproven, although one needs to be careful not to get drawn to crank theories in the opposite too. So do your own research with an open mind.

There is a clear need for good health and wholesome lifestyle as a first step, and to be pragmatic it may be best to live in the west if poss, and it may not need to go beyond that, but failing that it is clear that drugs are becoming ever better at boosting the immune system and combatting associated conditions.

Personally, I doubt some of the science, but think that HIV+ test does suggest immune impairment.

[slimdog]

Thanks for all the replies everyone.

I'd just like to update everyone on what has happened so far in case you're curious and perhaps my info can help anyone there too.

My friend went to re-test his HIV status. He's confirmed HIV+.

He also did some examination. He has some symptoms - swollen glands.

His CD4 cell count is 331, CD4 % 20.3%. His viral load is 13,800.00.

Well the good news is that his viral load is still fairly low. Generally the higher the viral load the greater the deterioration of cd4 cells. The cd4 count is fairly low, but from personal experience, the cd4 count does go up and down like a yoyo, and if your friend is in the condition that you descibe, then in all likelihood, his cd4 count is about the lowest it is likely to get at present. With reasonable care, meaning good nutrition, plenty of sleep and stress levels reduced, the cd4 count should rise quite considerably, and give both your friend and his doctors a better overall view of his current status

With these results, the doctor advised to do a:

A) Hepatitis Ag and Ab test. He's clear but not immunized.

Repeat his CD4 test in a months' time.

C) Do a HIV Genotype test.

D) Urine exam for syphillis.

If he hasn't already has a hepatitus C test, then would advise he undergoes one. Also, it would be advisable to get a flu shot.

Agree with repeating the cd4 test in a months time. Delay it if neccessary until your friend is getting plenty of sleep, and his stress levels are reduced somewhat.

Not sure why they are asking to do a Genotype test for. The medication available today is just as effective with all the various strains of hiv.

Make sure your friend has tests for all common std's

When he wanted to do the geno test and the Hep immunization, the nurse & doctor told him that he is currently not in a good state of mind and body because he's in still a state of shock and being in this state of mind and body would affect the results of the tests that he was supposed to do. He had no motivation, no appetite, crying all day and night and thinking about death, avoiding all friends and being in a state of panic thinking about medication straightaway. What's worse, he may lose his job due to the current recession.

Also the doctor said that he needs to do a series of CD4 tests to check whether he really needs to take medication or not. There's no point to take medication too early or else it will not be effective if it's not required.

Make sure you friend is fully aware of all the pro's and cons regarding when to start medication. For me it was never an issue as my cd4 count was virtually non existant, but from what my doctor has said, there is still no clear consensus amongst the medical profession. Going onto medication early generally means that the chances are that your cd4 count will be higher, whilst the medication will never get the count up to it's original level, it should still rise to a reasonable level. The drawback in starting medication early is that over time, the medication may stop being as effective, this was particularly worrying a number of years ago, but seems to be becoming less of an issue with the newer drugs available today.

I told him that needs to try very hard to be strong and think positive, which I'm sure is very hard to do in his situation. After days of comforting him, when I thought he was ready, I told him straight-up and said that nobody lives forever, and you should live the life you want to live and don't let this stop from doing whatever you're doing. With medication nowadays, people with HIV+ can possibly live longer if they maintain a healthy lifestyle.

He has hope and moving on slowly. He has started to eat well again, going back to the gym like his normal schedule, and smoking less to nil.

I've been giving him moral support and slowly day by day he's facing this. Hopefully in a month's time, his mood and state of mind is ready for these tests.

It will take quite a while to come to terms with being hiv+, but it does happen, it just takes time. For me the first month was a nightmare, and it it took nearly 12 months when I can honestly say, I didn't think about it nearly every day. Now after more than 5 years, I can say that I am fully accepting of my hiv status, thinking about it rarely. Having someone, you can confide in is absolutely a must.

You have been a good friend..

[orchis]

quote Going onto medication early generally means that the chances are that your cd4 count will be higher, whilst the medication will never get the count up to it's original level, it should still rise to a reasonable level unquote slimdog

This statement is confusing in my opinion and not necessarily true. My cd 4 s were back in the normal range after 1 year of treatment. I started medication upon hiv diagnosis at 220 cd 4/ vl 500 000 and have been around 1000 cd 4 (one thousand) for the last 10 years. Also medication efficiency has never failed me. I changed meds only when meds with less side effects became available.

Edited April 29, 2009 by orchis

[OldenAtwoody]

Thanks for all the replies everyone.

I'd just like to update everyone on what has happened so far in case you're curious and perhaps my info can help anyone there too.

My friend went to re-test his HIV status. He's confirmed HIV+.

He also did some examination. He has some symptoms - swollen glands.

His CD4 cell count is 331, CD4 % 20.3%. His viral load is 13,800.00.

With these results, the doctor advised to do a:

A) Hepatitis Ag and Ab test. He's clear but not immunized.

Repeat his CD4 test in a months' time.

C) Do a HIV Genotype test.

D) Urine exam for syphillis.

When he wanted to do the geno test and the Hep immunization, the nurse & doctor told him that he is currently not in a good state of mind and body because he's in still a state of shock and being in this state of mind and body would affect the results of the tests that he was supposed to do. He had no motivation, no appetite, crying all day and night and thinking about death, avoiding all friends and being in a state of panic thinking about medication straightaway. What's worse, he may lose his job due to the current recession.

Also the doctor said that he needs to do a series of CD4 tests to check whether he really needs to take medication or not. There's no point to take medication too early or else it will not be effective if it's not required.

I told him that needs to try very hard to be strong and think positive, which I'm sure is very hard to do in his situation. After days of comforting him, when I thought he was ready, I told him straight-up and said that nobody lives forever, and you should live the life you want to live and don't let this stop from doing whatever you're doing. With medication nowadays, people with HIV+ can possibly live longer if they maintain a healthy lifestyle.

He has hope and moving on slowly. He has started to eat well again, going back to the gym like his normal schedule, and smoking less to nil.

I've been giving him moral support and slowly day by day he's facing this. Hopefully in a month's time, his mood and state of mind is ready for these tests.

Depending on his finances, age, etc., he might want to consider to associate with an AIDS hospice, perhaps upcountry, and care for people in worse circumstances than he. Countless HIV+ orphans could use a lift in spirits, and I daresay, he'd be part of a larger support group, and no longer alone. Even for a short stint, this experince could give him the real hope he needs to feel like he's making a differnce.

[Sheryl]

Your friend has been getting excellent medical advice and you have been providing the support and friendship that he needs.

The one thing missing that I think would help a great deal would be for him to join a support group of persons with HIV. It is one thing for the docotr, or you, to tell him that his life will go on and that this is a condition that can be managed and lived with productively; it will be quite another for him to actually meet people who have gone through what he is going through now and been able to rebound from that and are now living normal lives.

If he is Thai and in the Bangkok area, try the "Wednesday Friend's Club" which meets at the Thai Red Cross, call 0-2253-2666 for details.

If he is farang there is a small sized support group for farangs with HIV which I know of, send me a PM and I will arrnage to put you in touch with them.

And do have him check out www.thebody.com, excellent source of comprehensive info on HIV. The site is maintained by and for people who are HIV+

[bobbysan124]

I think one of the best things you can do is what you are doing - being a good, concerned and empathetic friend. Good luck in the long term for your friend.

[geriatrickid]

The medical advice given as reported is textbook perfect. HIV infection is not a one size fits all infection, but then again no infection is. There will be common symptoms, complications and treatment regimes but each patient does have individual and specific requirements, hence the genotype identification exercise.

The literature reports that rapid accumulation of resistance mutations in the genome of human immunodeficiency virus (HIV) plays a central role in drug treatment failure in infected patients. Treatment decisions are guided by information on resistance obtained from the viral genome or from phenotypic resistance tests. The catch is that you have to be expperienced and up to date to fully understand the bioinformatic data. If the doctor wants to know what he's dealing with in the patient, then that's reassuring and indicative of someone that knows what he's doing. In the west, 15 antiretrovirals are available. In Thailand they usually draw upon 10. 3 drug classes, all targeting 2 viral enzymes, so the options and combinations are limited. To obtain the best results you have to use the best fit method and genotyping lets you do that.

[jboras]

Thanks for all the replies everyone.

I'd just like to update everyone on what has happened so far in case you're curious and perhaps my info can help anyone there too.

My friend went to re-test his HIV status. He's confirmed HIV+.

He also did some examination. He has some symptoms - swollen glands.

His CD4 cell count is 331, CD4 % 20.3%. His viral load is 13,800.00.

With these results, the doctor advised to do a:

A) Hepatitis Ag and Ab test. He's clear but not immunized.

Repeat his CD4 test in a months' time.

C) Do a HIV Genotype test.

D) Urine exam for syphillis.

When he wanted to do the geno test and the Hep immunization, the nurse & doctor told him that he is currently not in a good state of mind and body because he's in still a state of shock and being in this state of mind and body would affect the results of the tests that he was supposed to do. He had no motivation, no appetite, crying all day and night and thinking about death, avoiding all friends and being in a state of panic thinking about medication straightaway. What's worse, he may lose his job due to the current recession.

Also the doctor said that he needs to do a series of CD4 tests to check whether he really needs to take medication or not. There's no point to take medication too early or else it will not be effective if it's not required.

I told him that needs to try very hard to be strong and think positive, which I'm sure is very hard to do in his situation. After days of comforting him, when I thought he was ready, I told him straight-up and said that nobody lives forever, and you should live the life you want to live and don't let this stop from doing whatever you're doing. With medication nowadays, people with HIV+ can possibly live longer if they maintain a healthy lifestyle.

He has hope and moving on slowly. He has started to eat well again, going back to the gym like his normal schedule, and smoking less to nil.

I've been giving him moral support and slowly day by day he's facing this. Hopefully in a month's time, his mood and state of mind is ready for these tests.

Hi,

I hope that your friend acts immediately and does not sit around some of these "stupid" answers I am seeing here (sorry guys but this guy needs help urgently!).

Your friends Cd4 count is very low <200 is considered in the AIDS category and medications may/may not work.

Your friends cd4% is extremely low not srprised given his low cd4 count.

What is surprising is is his viral load count which is not considered high. This would make me beleieve that your friend has been infected for quite some time and has only just found out now. He has probably been infecting others along the way if he has been having any type of un protected sex. A CD4 count of <500 makes a HIV carrier very infectious.

Your friend needs immediate action. Medications that he requires are not available in Thaniland for free! They cost. A Lot! Tell him to go home where he will get them for free, if he is British or Australian.

He must get on to a very good HIV specialist to start HAART imeediately! HAART = Highly active anti retroviral treatment.

Western countries have many combinations of HAART they can give to HIV people and they have options of chaning the combination of HAART should they be infected with a a mutatnt strain that has already developed resistence to some drugs.

In Thailand they will shake their head (doctors) and tell him he's got 3-6 months left. This is/could be reality if he does not start treatment. Your friend would have already noticed that he is forming mouth ulcers that just wont go away, skin on his face that just seems to peel of on it's own, herpes outbreaks that may be more frequent and difficult to rid of, and finally he may be having the sweaty nights while his body is trying to work out how to fight this HIV infection. Also he will be falling asleep every few hours as his body is just too fatigued fighting the infection.

Now to others he may just seem tired and quite normal.

HE IS VERY INFECTIOUS with the readung you show above and is dangerously low!

Get him home and get proper treatment for him. He will not get it in Thailand.

I know! I went through this 11 years ago, my reading similar to your friends and offered no help at all by any Thai doctors! Because they can't! I caught the plane home after I called my doctor back home. Lucky I did!

11 years later.

My CD4 is 2000+ (normal is 800-1200)

My CD4% 48% (normal is 46-48)

My VL Viral Load = undetectable that means they cannot find any virus when I test every year.

I have fathered 2 children since then and my wife is not HIV+. As my cd4 count is so high we dont use condoms.

I take my medications once a day it's just three pills and LIFE IS GREAT! WORKING AND LIVING NORMALLY!

BUT your friend must get a move on and not sit there feeling sorry arsed for himslef. There is help and it is NOT in THAILAND! Don't waste valuable time as his counter are seriously low.

Some good news for your friend:

When I tested at BNH 11 years ago:

My Cd4 = 260

My CD4% = 26%

Viral Load (tested in Australia, Thais didn't even know what this was) 65,000+

Once started the medications my counters became as they are now (above) 3 weeks after taking the medications! They work!

[jboras]

Thanks for all the replies everyone.

I'd just like to update everyone on what has happened so far in case you're curious and perhaps my info can help anyone there too.

My friend went to re-test his HIV status. He's confirmed HIV+.

He also did some examination. He has some symptoms - swollen glands.

His CD4 cell count is 331, CD4 % 20.3%. His viral load is 13,800.00.

With these results, the doctor advised to do a:

A) Hepatitis Ag and Ab test. He's clear but not immunized.

Repeat his CD4 test in a months' time.

C) Do a HIV Genotype test.

D) Urine exam for syphillis.

When he wanted to do the geno test and the Hep immunization, the nurse & doctor told him that he is currently not in a good state of mind and body because he's in still a state of shock and being in this state of mind and body would affect the results of the tests that he was supposed to do. He had no motivation, no appetite, crying all day and night and thinking about death, avoiding all friends and being in a state of panic thinking about medication straightaway. What's worse, he may lose his job due to the current recession.

Also the doctor said that he needs to do a series of CD4 tests to check whether he really needs to take medication or not. There's no point to take medication too early or else it will not be effective if it's not required.

I told him that needs to try very hard to be strong and think positive, which I'm sure is very hard to do in his situation. After days of comforting him, when I thought he was ready, I told him straight-up and said that nobody lives forever, and you should live the life you want to live and don't let this stop from doing whatever you're doing. With medication nowadays, people with HIV+ can possibly live longer if they maintain a healthy lifestyle.

He has hope and moving on slowly. He has started to eat well again, going back to the gym like his normal schedule, and smoking less to nil.

I've been giving him moral support and slowly day by day he's facing this. Hopefully in a month's time, his mood and state of mind is ready for these tests.

Hi,

I hope that your friend acts immediately and does not sit around some of these "stupid" answers I am seeing here (sorry guys but this guy needs help urgently!).

Your friends Cd4 count is very low <200 is considered in the AIDS category and medications may/may not work.

Your friends cd4% is extremely low not srprised given his low cd4 count.

What is surprising is is his viral load count which is not considered high. This would make me beleieve that your friend has been infected for quite some time and has only just found out now. He has probably been infecting others along the way if he has been having any type of un protected sex. A CD4 count of <500 makes a HIV carrier very infectious.

Your friend needs immediate action. Medications that he requires are not available in Thaniland for free! They cost. A Lot! Tell him to go home where he will get them for free, if he is British or Australian.

He must get on to a very good HIV specialist to start HAART imeediately! HAART = Highly active anti retroviral treatment.

Western countries have many combinations of HAART they can give to HIV people and they have options of chaning the combination of HAART should they be infected with a a mutatnt strain that has already developed resistence to some drugs.

In Thailand they will shake their head (doctors) and tell him he's got 3-6 months left. This is/could be reality if he does not start treatment. Your friend would have already noticed that he is forming mouth ulcers that just wont go away, skin on his face that just seems to peel of on it's own, herpes outbreaks that may be more frequent and difficult to rid of, and finally he may be having the sweaty nights while his body is trying to work out how to fight this HIV infection. Also he will be falling asleep every few hours as his body is just too fatigued fighting the infection.

Now to others he may just seem tired and quite normal.

HE IS VERY INFECTIOUS with the readung you show above and is dangerously low!

Get him home and get proper treatment for him. He will not get it in Thailand.

I know! I went through this 11 years ago, my reading similar to your friends and offered no help at all by any Thai doctors! Because they can't! I caught the plane home after I called my doctor back home. Lucky I did!

11 years later.

My CD4 is 2000+ (normal is 800-1200)

My CD4% 48% (normal is 46-48)

My VL Viral Load = undetectable that means they cannot find any virus when I test every year.

I have fathered 2 children since then and my wife is not HIV+. As my cd4 count is so high we dont use condoms.

I take my medications once a day it's just three pills and LIFE IS GREAT! WORKING AND LIVING NORMALLY!

BUT your friend must get a move on and not sit there feeling sorry arsed for himslef. There is help and it is NOT in THAILAND! Don't waste valuable time as his counter are seriously low.

Some good news for your friend:

When I tested at BNH 11 years ago:

My Cd4 = 260

My CD4% = 26%

Viral Load (tested in Australia, Thais didn't even know what this was) 65,000+

Once started the medications my counters became as they are now (above) 3 weeks after taking the medications! They work!

... and I forgot to mention uncontrolled diarhea (hope the spelling is understood)... running to the loo during a meal... many times....and he may be getting upset quite easily (with himeself and others around him) as he is frustrated by the fact that his energy levels are just zapped... my doctor said it was the onset of toxoplasmosis...

All cured now! But take medicine religiously every morning!

[BigSnake]

Remain a good friend, give all the support you can, when ever you can, little chat when ever time permit, on going to a sporting event or just plain old hang out for a cool afternoon by the pool. These little things can mean a lot to your friend or any friend for that matter

[rijb]

None of our business how he got it. He needs to confirm that he has it, and how advanced it is.

He didn't ask for a name and address. Would you dismiss these questions?

- How did he get in a motorcycle accident?

- How did he get robbed/killed?

- How/where did he contract swine flu?

A common theme in many threads/posts is people discussing lessons learned. The situation in this thread is very tragic and it scares people. Some questions are personal … for the person asking the question.

[Sheryl]

None of our business how he got it. He needs to confirm that he has it, and how advanced it is.

He didn't ask for a name and address. Would you dismiss these questions?

- How did he get in a motorcycle accident?

- How did he get robbed/killed?

- How/where did he contract swine flu?

A common theme in many threads/posts is people discussing lessons learned. The situation in this thread is very tragic and it scares people. Some questions are personal … for the person asking the question.

Given the very personal nature of HIV transmission I do not think one can compare it to a motor vehicle accident or flu etc.

This forum receives a lot of questions from people with sexually transmitted diseases and other illnesses of an intimate nature. It needs to be a place where people feel free to post such questions without shame, embarrassment or prying questions.

I would hope that all TV readers already know clearly how HIV is transmitted and what measures to take to avoid it. Knowing the details of how one person contacted it will add nothing to that. The guidance remains: consistent condom use with all sexual partners unless in the context of a mutually monogamous relationship (and one in which you are certain of the other person's fidelity). Avoiding sex with commercial sex workers altogether also a good idea (as condoms occasionally fall off) but if one won't or can't, at least be unfailing in condom use. End of story.

[Sheryl]

Your friends Cd4 count is very low <200 is considered in the AIDS category and medications may/may not work.

Your friends cd4% is extremely low not srprised given his low cd4 count.

What is surprising is is his viral load count which is not considered high. This would make me beleieve that your friend has been infected for quite some time and has only just found out now. He has probably been infecting others along the way if he has been having any type of un protected sex. A CD4 count of <500 makes a HIV carrier very infectious.

Your friend needs immediate action. Medications that he requires are not available in Thailand for free! They cost. A Lot! Tell him to go home where he will get them for free, if he is British or Australian.

He must get on to a very good HIV specialist to start HAART imeediately! HAART = Highly active anti retroviral treatment.

jboras, thanks for an informative post, but the CD4 is not <200, it is over 300. That together with a comparative low VL make the advice to defer HAART and follow the CD4 periodically not unreasonable. When to start treatment is a an area of debate even among physicians specializing in the field. There is agreement that it should start as soon as CD4 dips below 300, (although some governments for reason of cost will only provide free ARV at lower counts), general agreement not to treat when above 500 and differing views about treatment for people who fall between 300-500 with the VL often the deciding factor.

With CD of 331 and comparatively low VL decision to wait and follow the levels is not unreasonable in this case.

[jboras]

Your friends Cd4 count is very low <200 is considered in the AIDS category and medications may/may not work.

Your friends cd4% is extremely low not srprised given his low cd4 count.

What is surprising is is his viral load count which is not considered high. This would make me beleieve that your friend has been infected for quite some time and has only just found out now. He has probably been infecting others along the way if he has been having any type of un protected sex. A CD4 count of <500 makes a HIV carrier very infectious.

Your friend needs immediate action. Medications that he requires are not available in Thailand for free! They cost. A Lot! Tell him to go home where he will get them for free, if he is British or Australian.

He must get on to a very good HIV specialist to start HAART imeediately! HAART = Highly active anti retroviral treatment.

jboras, thanks for an informative post, but the CD4 is not <200, it is over 300. That together with a comparative low VL make the advice to defer HAART and follow the CD4 periodically not unreasonable. When to start treatment is a an area of debate even among physicians specializing in the field. There is agreement that it should start as soon as CD4 dips below 300, (although some governments for reason of cost will only provide free ARV at lower counts), general agreement not to treat when above 500 and differing views about treatment for people who fall between 300-500 with the VL often the deciding factor.

With CD of 331 and comparatively low VL decision to wait and follow the levels is not unreasonable in this case.

Hi,

I should have left that out and not start a debate about when to start therapy.

I put the counter there as my doctor; when he first talked to me 11 years ago tried to explain HIV/AIDS relationship to me.

To clarify:

if CD4 < 200 or

patient displays more than 3 type of infections/illensess he can be classified as an AIDS patient rather than HIV patient.

What I have found out over the years of battling/living with this disease... DEFINITIONS mean nothing...

You are infected with HIV you have AIDS full stop!

It's only a mattaer of time before your immune system looses its battle to this virus (and it will without treeatment) and gives up and you die! My doctor said why wait! Start early and stop the bloody thing in its tracks! Better to tackle the virus while your friend is healthy than to wait until he is sick! Believe me it's not nice! Not nice at all! and.. I was just mildly sick...

I have seen people at the Center where I go for testing annually, their counters are better than what mine were at the start but the medications just dont seem to help. The virus has mutated so much and if your friend is infected with a virus that is already resistant to the drugs, they won't help he will die. Good news is that new variants of the drugs are coming out faster than the virus can mutate and they are ahead of it. I am talking about Australia, I do not know where your friend is from. HIV drugs in Australia and testing is FREE! for Australians that is...

My advise to you to give to your friend.. go home... if he is from UK.. get a good doctor and start therapy immediately. I am sure UK like Australia if your friend is <500 will give him the drug therapy free... It's a matter of life or death.

Once he starts his therapy immediately (with me 3-4 days) he will feel fantastic. He will be able to stay awake all day, go for walks, he will feel re-born! IF THE DRUGS WORK! It's amazing the feeling you get, it's like you get a new body! I never realised just how sick I was until that time... The night sweats stopped, my peeling skin on my face dissapeared and all my mouth ulcers vanished. AND I started talking to my frinds with sense once again. If this was 2000 years ago I would have called it a miracle and my doctor certainly deserved the title of you know who!

His doctor within 3 weeks will call him back for a test and he should be close to undetectable Viral Load if not within 3 months he shouldbe undetectable. If he takes his medicine he will stay like that forever.. have children and not infect others, even with unprotected sex.

The Thai doctor (Dr. Kesanee at BNH) gave me 3-6 months of life (in 1998) and said "Sorry not much we can do for you! So sorry!" Boy was she wrong! It took me a few days to get over the initial shock... "Shit that's it I am dying" and I am glad I got on the phone to Australia and somebody talked to me straight telling me to get on the next plane "home". That word "home" never sounded so good even though it was coming from a stranger.

WARNING! There are lots of crack pots out there, natural therapies, blood transfussions, etc, etc.. THEY DONT WORK!

ONLY DRUGS USED BY YOUR GOVERMENT WORK! NOTHING ELSE..... NOT EVEN PRAYERS!

Sorry to be blunt! But with quick action your friend may outlive you and be very healthy until he is an old man and die of natural causes like a heart attack!

Please advise him to stop having sex or any exchange of bodily fluids as at the moment he is very infectious.

He may infect loved ones that may not have easy access to the medicines like a Thai companion!

If you need to talk to my doctor, .... I can pass you his details if this forum allows. He is currently lecturing at the Queensland University to Virology majors.

The drugs I am on are 1 Tablet of Viramune and 2 tablets of Truvada. (This dosage will vary depending on body weight I am 100Kg) Once a day. That's it! I forget that I even have HIV! LIFE IS GREAT!

[orchis]

I disagree. My experience is totally different. I have had hiv for 11 years, never went into having aids.

(no cd 4 below 200, no opportunistic infections)

You can go "home" if you want to, but it's not necessary. Care is good and plenty here.

You have to be proactive and surf a litlle or ask around.

I was diagnosed in 1997. I started drugs immediately, my cd 4 at 220 - not sick though, stayed in Thailand, kept my job leading a company.

It's not like that for everyone but it's so for a majority of hiv positive people now.

After a few months on meds my cd 4 s were back to normal and they stayed that way.

The last few years I switched to generic Thai retroviral drugs. The chemical molecules of these drugs

are identical to those of brand medicine. Monthly med costs and testing are affordable (see pinned information in this forum).

The doctors are good in Thailand,there's so much hiv around they realy are experienced.

My doctor goes to all the aids conferences and is very abreast of all new developments (Paitoon BGH), we meet monthly and I ask my questions based

on what I read up on.

Ok, time to take my meds. (one time daily). Good Health!

Edited May 4, 2009 by orchis

[jboras]

I disagree. My experience is totally different. I have had hiv for 11 years, never went into having aids.

(no cd 4 below 200, no opportunistic infections)

You can go "home" if you want to, but it's not necessary. Care is good and plenty here.

You have to be proactive and surf a litlle or ask around.

I was diagnosed in 1997. I started drugs immediately, my cd 4 at 220 - not sick though, stayed in Thailand, kept my job leading a company.

It's not like that for everyone but it's so for a majority of hiv positive people now.

After a few months on meds my cd 4 s were back to normal and they stayed that way.

The last few years I switched to generic Thai retroviral drugs. The chemical molecules of these drugs

are identical to those of brand medicine. Monthly med costs and testing are affordable (see pinned information in this forum).

The doctors are good in Thailand,there's so much hiv around they realy are experienced.

My doctor goes to all the aids conferences and is very abreast of all new developments (Paitoon BGH), we meet monthly and I ask my questions based

on what I read up on.

Ok, time to take my meds. (one time daily). Good Health!

Like I said!

I didn't want to start a debate as to when HIV becomes AIDS. There will be as many differing opinions as there are people in the arguement!

AIDS = Acquired Immune Defficiency Syndrome. (Like.... your immune system becomes defficient because of a nasty virus we caught and it just can't help or repair itself!)

Stop your medications and tell me if you have AIDS or not!

Please don't I am only joking I dont want you developing any resistance to your medical combination!

I have seen many a young people (here in Thailand) die since my infections as they thought "I have HIV not AIDS" and not seeking help! Some helathy that "melted" away in a matter of a few months! Also they had no access to the drugs!

If things have changed in Thailand and people can get "FREE" meds or cheap meds great!

I still visit Australia once a year to get my supplies of meds replenished "free" and get my testing done "free".

If Thailand has changed great!!!! When I went to BNH in April 1998 I was told to make "funeral arrangements"! That the drugs only work for a while. This was the HIV specialist at BNH then... I hope she is still not there!!

You know that in Africa they still believe that HIV and AIDS are not related.

I hope you don't agree and give HIV+ people advise as such!

It's cruel!

[bangon04]

His doctor within 3 weeks will call him back for a test and he should be close to undetectable Viral Load if not within 3 months he shouldbe undetectable. If he takes his medicine he will stay like that forever.. have children and not infect others, even with unprotected sex.

Sheryl - isn't this a bit dangerous to leave it unchallenged?

[bangon04]

11 years later.

My CD4 is 2000+ (normal is 800-1200)

My CD4% 48% (normal is 46-48)

My VL Viral Load = undetectable that means they cannot find any virus when I test every year.

I have fathered 2 children since then and my wife is not HIV+. As my cd4 count is so high we dont use condoms.

Sheryl - can you at least comment on this? It seems to go against the general wisdom...

[Sheryl]

11 years later.

My CD4 is 2000+ (normal is 800-1200)

My CD4% 48% (normal is 46-48)

My VL Viral Load = undetectable that means they cannot find any virus when I test every year.

I have fathered 2 children since then and my wife is not HIV+. As my cd4 count is so high we dont use condoms.

Sheryl - can you at least comment on this? It seems to go against the general wisdom...

CD4 count is irrelevant to the need for condom use, it measures the extent to which the immune system is impaired not the degree of infectivity; it is the viral load that measures the latter.

With modern drugs many patients are able to reach a point where they have no detectable virus in the blood. They are still not cured, because the HIV virus is able to hide in lymphatic tissue and would resurface if the medication were stopped. However, their blood and bodily fluids no longer contain any detectable virus.

Recent research done on serodiscordant couples (one partner HIV positive and the other negative) suggests that the risk of HIV transmission in cases where the Viral Load (VL) is undetectable is very low to nil, and there has been discussion about whether or not such couples could safely stop condom use. AFAIK no uniform consensus has emerged on this and I think there is unlikely to be a stated policy recommendation for fear that it could be misunderstood/misused, e.g. people who still have detectable VLs might also stop using condoms, or uninfected people might rationalize that it is OK to have unprotected sex with HIV+ people who have long been on treatment without actually knowing for sure that they are without a detectable VL. Public health officials have worked long and hard to promote condom use as a means of preventing HIV -- with excellent results in countries where behavior change has occurred -- and the last thing anyone wants to do is to jeopardize this with a nuanced message that would apply only to a very specific subset of people.

However many individual doctors do tell patients with undetectable VLs who are in monogamous relationships and appear responsible and sophisticated enough to understand and make an informed decision, that the risk of transmission is close to nil as long as their VL remains undetectable -- and then let the couple make their own informed decision based on that information.

There would remain the possibility that the infected person might subsequently develop virus in the blood (e.g. due to newly developed drug resistance, or from unprotected sex with another person who had a high VL etc) and then infect their partner prior to the change in VL being detected. Certainly if a couple in this situation opts to discontinue condom use, VLs should be done with greater frequency.

This has relevance only in a situation where (1) the VL of the infected person is known with certainty to be undetectable; (2) the infected person remains fully compliant with their medications; (3) the couple is strictly monogamous and (4) the uninfected partner has a clear understanding of the possible risks and makes an informed choice to dispense with condom use.

[patklang]

None of our business how he got it. He needs to confirm that he has it, and how advanced it is.

So if he got it in nana and told everyone who she/he was,you say its non of our business,excuse me i think it is our business unless you want this disease to spread.If i got hiv from a bg i would be shouting it from the top story.

Why did you say its non of our business??????