SEPTEMBER 1998

NUMBER ONE

Play Your Hand
Monitoring your health puts cards in your deck.

HIV-positive people with a falling or low T-cell count and a high viral load are at greater risk for developing HIV-related opportunistic infections. To monitor your health and progress on any treatment regimen, a range of laboratory tests are used. Here's a checklist:

• Complete physical exam.
• Baseline T-cell and viral-load tests (see below).
• Basic medical tests: routine blood chemistry (including cell counts, Beta 2-microglobulin, liver enzymes (SCOT, SGPT) and neopterin levels, serum creatinine, neurologic-function test, urinalysis, and chest X ray.
• An anergy skin panel to test your immune responses.
• Women: gynecological screening (vaginal, pelvic, breast) and Pap smears; treat STD infections.
• Eye exam.
• Dental exam: Fill any cavities, because HIV can grow in them.
• Baseline nutritional level exam and diet review by a nutritionist.
• STD screening, including syphilis (use MHATP). If negative, discuss possible past exposure with your doctor.
• Baseline toxoplasmosis IgG test; also tests for MAC, CMV.
• Baseline tuberculosis PPD: If positive at 5 mm, treat (see "HIV Illnesses").
• Avoid parasites in water: Use a water filter. Boil water when traveling.
• For babies: change diapers regularly.

Adult Vaccinations:

• Consider hepatitis A and B vaccine (if negative for syphilis), a three-shot series; test for hepatitis C.
• A flu shot every October. (Shots can cause a transient increase in viral load, so wait 4-6 weeks for a viral-load test.)

T-Cell and Viral Load: Experts recommend two blood tests prior to beginning any course of therapy: a T-cell (or CD4+) test measures both the absolute count and the ratio of your immune T-cells. A viral-load test measures the amount of virus in your blood. If you're taking HIV meds, both tests are recommended every 3-4 months.

T-Cells: The normal T-cell range in a healthy persons is 300-1200 T-cells per milliliter. A person with more than 500 T-cells is considered at low risk for HIV symptoms. If your T-cells fall below 500, consider this a warning sign. A drop below 200 puts you at high risk for HIV-related infections. A tip: Watch for trends over time; T-cells levels can fluctuate for many reasons.

Viral-Load Tests: Two commercial viral-load tests are used to measure HIV: a branched DNA (bDNA) test measures down to 400 copies per milliliter, and a reverse transcriptase polymerase chain reaction (RT-PCR) tests down to 500 copies. An "undetectable" viral load falls below these levels. Researchers can use Hoffmann-La Roche's more sensitive test, called Amplicor HIV 1 Monitor Ultra Sensitive test that goes down to 50 copies, or Organon Teknika's Nuclisense HIV-1 QT test. New proviral DNA tests are out by Hoffmann- La Roche as well as LabCorp of America.

Using Viral-Load Tests:

• Before starting treatment, get two initial viral-load measurements two weeks apart to establish baseline viral activity.
• Measure viral load again 2-4 weeks after therapy begins or when changing regimens.
• Repeat viral-load tests every 3-4 months, along with T-cell counts.
• Use the same type of viral-load test each time.

Treatment Goal: Look for a one-log (tenfold) drop in viral load within four weeks. The long-term goal is maintenance of viral load at "undetectable" levels-that is, below the level of detection.

Drug Failure: A new regimen is viewed as failing if your viral load rebounds after four months to any level, or to within 0.3-0.5 log of pre-treatment level. Ask your doctor about alternative treatment.