Spreadsheet and Graph to monitor my progression

In my twitter @sgpozsterboy, I promised to share how I monitored my progression before and after starting medication.

Okay, please spare this geek some time and carry on reading. For the following, I used Microsoft Excel. What I did was to put all the data I have from every blood test into a table with the dates (blurred to protect my identity, yes I am that careful) and other necessary data. You will notice that I have the heading "days". I made the first day I took my blood test as "day 1" and subsequently started counting the days of the other tests from this date. The reason for doing this is to allow a graph to be plotted to gauge roughly when to start my medication.

I then plotted a graph with the horizontal axis being "no of days" and the vertical axis "CD4 counts". I told myself that I will start to seriously consider when to start my medication when my CD4 cells falls around "200 - 350" but NOT below "200".


After you get the plot in, I got the program to plot in the "trendline" and add in the equation. There is an assumption here that the decline of CD4 cells is linear, meaning it will continue to fall at a same uniform rate. In other words, IF every month it falls 10, then I am assuming that it will continue to fall 10 per month. Of course there is not guarantee that it will continue to fall at the same rate. CD4 rates are known to fluctuate and may drop suddenly drastically especially when one is ill with common illness so I knew I had to be careful using the data here.


So once I had the trendline and equation which in this case is 


y = -0.0836x + 458.33

So, once I had this equation, I did a simple substitution and I got a rough guage of when I will need to start medication. For eg, let's say I tell myself to start medication when my CD4 drops to 350. What I will do is to substitute "y" with 350. (Recall, the y axis or vertical axis represents CD4 counts). By solving the equation for x, I will get the number of days and from there I can calculate how much more time I have.

350 = -0.0836x + 458.33
350 - 458.33 = -0.0836x
-108.33 = -0.0836x
x = -108.33 / -0.0836
x = 1295.81

So roughly about 1295.81 days from the first day of test, I should consider starting my medication.

HEY! IS THERE ANYTHING WRONG WITH MY CALCULATION? If you look at the table, 1295th day was up LONG AGO. Yes, if you've been reading carefully, you will notice that my last few test results had increase in CD4 counts (I started medication) and because of this, it affected the equation. The graph with all the downward trend was before I started medication. After I started medication, you can see that the CD4 immediately shot up within 3 months.

Things to note:


The school of thought regarding when to start treatment has changed quite drastically within the last year. Right now, clinicians think that is best to start immediately after one is diagnosed. The reason is that once your CD4 cells go below a certain level, it is really quite hard to get it back up again and may require a longer time. Another way to think of it is to think of taking medication early has a preventive measure to protecting your immune system before HIV affects it too much. However, HIV meds are heavy on the liver and kidneys as well as on the pocket especially when you are a student. (I recently found out that first line meds are available at less than $300 per month.)

Medication is recommended also for couples whom one is HIV+ and one who is not. Recent findings show that this is reduce transmission rates. That being said, it doesn't mean you can go barebacking with your HIV+ bf if you're on medication. It just means that the chances are lowered. It doesn't mean transmission cannot happen. Don't forget, HIV medications are only effective against HIV. Other nasty infections are still possible. Effective condom use along with close adherence to the medication regiment is currently our best weapon against the spread of HIV.

The information here is meant to let you all know that one can be control of one's HIV condition. Always discuss with your doctor your concerns.

Partying post medication

Someone brought up an interesting topic the other day on my twitter account @sgpozsterboy. He asked what were some of the changes or things to look out for after starting meds.

Prior to starting meds, I was preparing myself mentally to let go a lot of my late night partying and drinking. My closest friends will recall numerous "MY LAST PARTY" I organised as D-Day approached. Then I discovered that actually there were few drug interactions with my medication. That being said, I still felt the need to take care of my liver and kidneys because I need them to work for me for as long as possible. You may not know, while people do not die from AIDS anymore, people do die from other possible side effects like hepatic (liver) toxicity or renal (kidney) toxicity from the medication.

So here's what I always do. I take my medication either 4 hours before midnight or at most 4 hours after midnight. (Midnight being the time I always take my medication). The idea is to maintain the serum concentration in the blood to surpress the virus. There is no empirical data to support why I chose 4 hours but I reckoned that since the recommendation if you missed a dose is to take the dose immediately OR to skip the dose if the timing is near to the next dose already, then serum concentration would not have dropped to drastically to the virus to return.

I also watch the amount of things I take it while partying. No longer do I go on binges and endless amount of alcohol. Partly also because I do not want to return home and miss my dose of medication. Worse still, having my precious liver work on with the alcohol and medication at the same time.

As life changed much after medication? I feel that it has definitely taken a turn for the better. I am no longer tired like I always was before. Mentally I feel more optimistic and while partying, I feel more in control. Thankfully I have a small group of friends whom I club with regularly. They watch out for me and warn me if I'm going overboard with the drinks (which can be quite a damper sometimes).

Coping with oral ulcers and sore throat.

The main reason why I started this blog and my twitter account @sgpozsterboy was to share to experience as a gay man living with HIV. I hope that in sharing my experiences, people like me will know that they are not alone and will also learn ways of coping with the annoyance that may crop up from time to time.


Prior to starting my medication, I frequently suffer from multiple oral ulcers and at times some of these ulcers can develop on the oropharynx, soft palate, uvula or the palatine tonsil. 


See here: http://theslowdog.com/speech-pathology/anatomy-of-the-oral-cavity/


They make swallowing, (I'm referring to food) extremely difficult and painful. So I developed my regime to cope with it over the years. The method I use basically only treats the condition symptomatically because believe the cause to be viral in nature. In other words, I am unable to treat the root cause so I only treat it by 


1) killing the pain and discomfort
2) maintaining high oral hygiene to prevent secondary infections


If the pain is mild, I will just gargle my mouth with Difflam with Benzydamine which kills the pain but leaves a rather rubbery feeling in the mouth after use. I also find that it affects the taste buds so if you gargle with this before a meal, you can be sure that the meal tastes rather ... bland. 

In occasions where the ulcers make it extremely excruciating to swallow, I will take Nurofen. The reason why I used this painkiller was because I find that the common panadol or paracetamol does little to kill the pain. Nurofen is an NSAID (non-steroidal anti-inflammatory drugs) so it also reduces inflammation. 

To help ulcers heal faster, I use ORACOT E paste. This is a steriod paste which contains a painkiller. I usually apply this after a meal after brushing my teeth and gargling and before I sleep. This paste seals the ulcers up and promotes healing. Together with its painkilling ingredients, it feels like magic after every application. The pain just simply disappears.

I decide what to use based on how painful the ulcers are. As far as possible, I try not to take too much Nurofen (though they actually work the best) because I have this fear that taking too much of it will wreak my liver and kidneys which are important to me when I eventually start medication.  I am just paranoid. I also remember that I must have enough sleep and keep stress level low whenever possible because I noticed that whenever I do not get enough sleep or when I am stressed, those annoying ulcers come back to haunt me.


Since starting medication, I have not used any of these at all because there has been no recurrence of of ulcers. 


ORACORT E and Nurofen can be bought from Guardian or Watson's but you will need the pharmacist to be there. 


I have to reiterate that the methods I have mentioned here worked for me and I experienced no side effects so far. However, it is good to discuss with your doctor before self-medicating.


Hope this helps. 

The Mr in my life

Decided to write something about him today because I think we crossed another milestone today. I asked if he would like to move in with me but he apologetically said he couldn't. As expected it was because he is needs to take care of his aged parents. A completely valid reason and I accept it.

So, I bet you all are curious if he is HIV+ like me. No he is not. He is negative and we've been having hot raunchy sex regularly together for the past 6-7 years. This goes to show that effective condom use is effective in preventing HIV transmission. Now that I've started the medication, my viral load is undetectable in my blood and this further lowers any chances of transmission. In the past, I'm always close to nervous breakdown when he goes for his HIV test. Because I don't know if i can accept the guilt if he is ever infected by me.

So anyway, back to the happy stuff. How did we meet? We met each other on the red and white coloured local gay website. Hit it off right from the start but i held off having any intimacy with him for almost half a yr because of my status. As mentioned in my previous post, I keep my status a secret. When I finally decided to tell him, I remember we were sitting on the pavement of a road near my place. I told him I have something important to tell him and I spilled.

He looked at me and that moment felt like an eternity because I didn't know how he'll react. I told him if he chose to walk away, I can understand. Instead, he smiled and hugged me and told me it's ok.

Later that week, we did it. Gosh, it was so gd. To be honest, I slept around a lot and because of my boyish looks and muscular body, I never had a lack of people who I can call and will definitely give me a gd fuck. With him, it felt different and since then, I never slept around again. He is older than me, sports a goatie, muscular, tanned, sporty, fucks real gd and has a ahem... big one. However, the thing that attracted me to him is his kind heart. He would go out of the way to help friends or even strangers. And that trait captivated me.

About a month later while we were on an overhead bridge in town, he hopped closer to me and whispered into my ear if I am willing to be his boyfriend. Now, it was his turn to feel that the moment seemed like an eternity because I was caught off guard. Then I coyly said yes!

In him I found the perfect partner, someone whom I am so physically and intellectually attracted to. Someone who is able to tame the wild, bratty animal in me and make me a better person.

So this is the story of him and me in a nutshell. On this day when I felt we have reached yet another milestone in our journey together.

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What every newly diagnosed HIV+ person should know.

(I hope the information here will be useful for people who are newly diagnosed with HIV. The information here is only a snapshot of what worked for me. Please always consult your doctor because he/she will have a clearer picture of your overall health.)

This is not a death sentence and you are not going to die in the next 10-20 years if you take care of yourself. When I was newly diagnosed at AFA's anonymous test site in 2002, the doctor told me one thing and it made me feel a lot better. "Having HIV is like having a chronic illness, not unlike diabetes or kidney problems. In fact, kidney patients have it a lot worse." That was the statement that gave me hope and since my diagnosis, I had never suffered any depression partly because those who subsequently knew about me had been very supportive and did not treat me any differently. Stay optimistic. It really helps. Most people I know started treatment within 3-4 years. I only started treatment in late 2011. This brings me to my first point:

1) Choose who you tell about your status carefully. 

I tell people about my status on a "need-to-know-basis". That means that if there is no need for them to know, I won't tell them. After my diagnosis, I immediately told my 3 best friends. I was very sure that they will accept me even if I am positive. My advice to people who are newly diagnosed is that if you have the slightest shred of uncertainty as to whether a friend will accept you, I suggest you hold back until you are very sure. The reason why I say this is because you do not want to risk falling into depression because of rejection. Like I said before, take care of your health. Optimism will really go a long way in your fight against this infection. You are not alone in this. If you need help, Action for AIDS has got support groups with for pozzies like us. 

2) The Science of HIV. (The more you know, the less fear you will have).

It is very important that every newly diagnosed HIV+ arm themselves with knowledge about the infection. HIV is not AIDS. HIV the name of a virus (Human Immunodeficiency Virus) and AIDS (Acquired Immune Deficiency Syndrome). HIV causes AIDS, just like the Influenza Virus causes Flu. HIV infection, if left untreated, will lead to AIDS. Bear in mind this is something we do not want and we take medication to prevent this from happening. Here is a very simplified explanation:

In your body, there are white blood cells that help fight infection. HIV infect and kill some of these white blood cells, specifically the CD4 cells and causes your body to be unable to fight simple infections. Throughout the course of your infection your CD4 cell numbers will keep on dropping. 

An HIV+ person is considered to have AIDS if:

i) he has an infection that normal healthy people usually will not have OR

ii) CD4 cell counts are below 200.

The main idea of HIV medication is to keep the CD4 cell counts above 200 because from statistics, if the cell counts fall below 200, chances of those HIV-related infections surfacing becomes high.

CD4 cell counts and Viral Load

Rule: Keep CD4 cell counts high, Viral Load low

CD4:

So for a start, a newly diagnosed person should always go for a test to find out the current CD4 cell counts and monitor it. You doctor may start you off medication when you CD4 cell counts drop below 500 or 350 depending. Nowadays, it's a common practice to start medication if CD4 drops below 500. Prior to starting medication, my CD was between 530 to 260. 

Viral Load:

This can be defined very loosely as the amount of HIV in your blood. As mentioned before, you want to keep this number low. CD4 numbers should always be read together with Viral Load numbers to get a clearly "feel" of the chances of infection progressing to AIDS. If CD4 is above 500 and VL is low, then chances are you can still wait a while before started medication. But if CD4 is high and VL is high too then you may want to consider starting medication soon. What is considered a high VL? I would consider VL of 500 000 to 1 million to be very high. Prior to starting medication, my VL was between 60 000 to 3 000 copies. 

3) How often should I do my CD4 and VL tests?

If you have been diagnosed in Singapore in any other ways other than AFA's anonymous clinics or test sites then your records will be forward to CDC. CDC will take care of you from then on. So I think it's a trade off. I was a non-reported case because I was diagnosed at the anonymous clinic. Because of my specific field of education, I was confident in monitoring my infection progression. Below is what I did from 2002 to 2011.

Initially, when my CD4 was still high, I monitored my CD4 counts once every 6 months. When it fell to 350 and below, I monitored it once every 3 months. I did my tests in Bangkok's Anonymous Clinic in the Red Cross. The staff is friendly and speaks English. They only run CD4 tests during certain hours in the day so that is something you need to take note of. So when you take the CD4 test, take the VL test as well. The good thing is that they'll email you the results. At the same time, I was seeing a specialist at Bangkok's Bumrungrad Hospital. This hospital is equivalent to or even better than our Mt. Elizabeth or Gleneagles and at a fraction of the price too. There is no need to see this specialist everytime you go Bangkok to do your CD4 and VL test. In fact, I only saw her once every year until I started my meds. Before, I started my meds, I had to see the doc who advised me on other additional tests to do before starting medication. Basically these tests will form the baseline information for determining whether my treatment is successful. There is also a need to run genetic tests on the HIV in your body to determine its type so that the doctor can recommend a suitable combination of medication. 

Work with your doctor. Even for those who are seeing doctors in CDC, always ask them questions when you are in doubt.

4) Supplements

I truly believe that my slow disease progression is due to 2 factors:

i) optimism and love

ii) selenium

iii) milk thistle

There has been several studies about the effect of selenium on HIV infection. I have read some research papers and that convinced me to start them. I think they helped a lot. You can get selenium from GNC. Dosage is 200mg per day.

Milk thistle can be bought from GNC as well. They help to protect your liver from all the rubbish party materials you ingest (you know what I am saying here. Your alcohol and what not....)

Take note: once you start medication, you may need to stop these supplements because they may interfere with the amount of medication in your blood.

(I hope the information here will be useful for people who are newly diagnosed with HIV. The information here is only a snapshot of what worked for me. Please always consult your doctor because he/she will have a clearer picture of your overall health.)

Bad week

I've had a very very bad week. Found out abt some rumour-mongering at my former workplace. Some people have so much free time on their hands and started spreading stories about me. Nothing about my condition but some stuff abt my "unprofessional conduct with some ladies at workplace". For goodness sake, you all are making yourself a laughing stock because unknown to all these idiots, I am gay. Geddit? Male homosexual. No sexual interests in females. I can't explain this in any simpler words. So stupid these pple, think I'll play their stupid game. Obviously you all are 1) jealous of my accomplishments 2) upset with my popularity with the clients and 3) fearful of my guts to call a spade a spade.

Go on and continue working there because that's probably the only place in society you can ever "make it". I do pity the good pple who have to continue to tolerate your incompetence.

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Familiarity breeds contempt

The drawback of being together for so long is that one is always judged by the way things have been. Meaning that no matter how hard or much you've changed for the person or how much you try, you're "always like that". "You're always behaving like this to me, you always do this, you always do that".

It stabs you right there in your heart. And knowing that no matter how hard you try to change, you'll still be that unreasonable person in his eyes, turns my heart cold.

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