My role here today: I will provide information that may help you better understand:
About the Numbers
HIV/AIDS and its treatment Lab tests used to track your health
Understanding Your Labs
I cannot provide personal medical advice for you
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What is HIV?
What is AIDS?
HIV (Human Immunodeficiency Virus) is a virus that attacks your body’s immune system
When there are not enough CD4 cells to provide protection from germs and infections, HIV infection can progress to AIDS (Acquired Immuno Deficiency Syndrome)
The immune system = millions of cells that fight germs and infections
Doctors generally believe that AIDS begins when the CD4 level in a person’s blood is less than 200 cells/mm3
HIV attacks white blood cells called CD4 cells (also known as T-helper cells) and reduces their numbers
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HIV in the United States
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What do HIV medicines do? Help to control HIV by reducing the growth of new virus Help keep your viral load down
Over 1 million people are living with HIV/AIDS1 More than 250,000 do not know they are infected1 Only half of those infected are receiving treatment2
Reduce viral load
Viral load = the amount of HIV in your blood
HIV medicines do not cure HIV infection or AIDS and do not reduce the risk of HIV transmission to others
Approximately 40,000 new people get HIV each year1
1. Glynn M, Rhodes P. Estimated HIV prevalence in the United States at the end of 2003. National HIV Prevention Conference; June 2005; Atlanta. Abstract 595. 2. The Henry J. Kaiser Family Foundation HIV/AIDS Policy Fact Sheet: The HIV/AIDS Epidemic in the United States; November 2005. Available at http://www.kff.org/hivaids/3029-06.cfm 5
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Why are labs important?
Tracking your health
Lab tests can help you and your healthcare provider:
Lab tests • HIV viral load
Decide when to start HIV treatment
• CD4 cell count
Decide which HIV medicines are best for you
• Complete blood count (CBC)
Know whether or not your medicines are working
• Lipids • Glucose (blood sugar)
Know if any of your medicines are causing side effects
• Liver function
Watch for other infections and problems
• Kidney function
Understanding your labs helps you take charge of your health.
• HIV drug resistance
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When should lab tests be done?
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What is a “normal” lab value?
When you are first diagnosed with HIV, and then usually every 3 to 6 months, or whenever your healthcare provider feels they are necessary
“Normal” or “reference range” values are found on a lab report
When you start taking medicines and before you switch to different medicines
If your labs are too high or too low, talk to your healthcare provider
Your lab results can be low, high or within normal range
Even when you are feeling OK, labs can tell you things about your body that you may not be able to see or feel.
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HIV viral load
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Understanding viral load test results A person with HIV can have a viral load from less than 50 copies to over 1,000,000 copies per milliliter of blood (copies/mL)
Measures the amount of HIV in your blood Very useful in deciding when to begin or change HIV medications
Less than 50 copies/mL = “undetectable” Undetectable does not mean the person is cured
The goal: Keep your viral load as low as possible.
One Goal: Undetectable
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CD4 cell count
Understanding CD4 cell count results
Measures the number of CD4 cells (also called T-helper cells) in your body
Results can be reported as two values: CD4 cell count
Tells you the health of your immune system The more CD4 cells you have, the stronger your immune system
500 –500 1,600 mm3 – 1,500 cells/mm3
CD4 cell percentage Fewer CD4 cells
may lead to
Increased infections 20% – 40%
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Complete blood count (CBC)
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White blood cell count (WBC) Reported as the number of cells in a cubic millimeter of blood (cells/mm3)
CBC test measures the amount of: White blood cells - Fight off infections Red blood cells (hematocrit, hemoglobin) - Carry oxygen throughout the body
4,000 – 11,000 cells/mm3
Platelets Low WBC
- Help blood to clot
High WBC
May be caused by: • Certain medications • Chemotherapy drugs • Long-term HIV infection
The CBC test is a useful measure of your overall health.
May be caused by: • Bacterial or other infection • Leukemia/bone marrow diseases
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Understanding red blood cell count results
Red blood cell count (RBC) Hematocrit: percentage of total blood volume made up of red blood cells
High RBCs are very rare Low RBCs = anemia. May be caused by:
Men: 40% – 54%
Iron/vitamin deficiency Internal/external bleeding (blood loss)
Women: 37% – 47%
HIV/other chronic infections
Hemoglobin: reported as grams per deciliter of blood (g/dL)
Medications, including certain HIV treatments Cancer and other diseases
Men: 14 – 18 g/dL
Women: 12 – 16 g/dL
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Platelets
Lipids (fats): triglycerides
Platelets are necessary for blood clotting
A type of fat the body uses to store energy
Low platelet counts (thrombocytopenia) can be caused by medications, other diseases or HIV infection itself
High levels are associated with an increased risk of heart disease
140,000 – 450,000 cells/mm3
Less than 150 mg/dL
Above 150 mg/dL
American Heart Association 19
Glucose (blood sugar)
Lipids (fats): total cholesterol
Fasting blood glucose (FBG) measures blood sugar after you have not eaten for at least 8 hours
Total cholesterol: LDL (“bad” cholesterol) + HDL (“good” cholesterol)
Less than 200 mg/dL
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Above 200 mg/dL
Less than 110 mg/dL
Above 110 mg/dL
Pre-diabetes = between 110 and 126 mg/dL
LDL and HDL cholesterol
Diabetes = 126 mg/dL or higher
LDL: Less than 130 mg/dL
High blood sugar can be controlled by diet and exercise, or by medications.
HDL: Above 40 mg/dL
American College of Endocrinology Consensus Statement on Guidelines of Glycemic Control. Endocr Pract. 2002;8(Suppl.1):5-11.
American Heart Association 21
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Kidney function tests
Liver function tests Blood tests that help to show how well your liver is working
Some HIV medicines may affect the kidneys
Important for anyone taking HIV medicines and other medications
These tests help to show how well your kidneys are working: Blood urea nitrogen (BUN)
The liver helps process medications and can become “overloaded”
7 – 20 mg/dL
Can identify possible:
Creatinine
Liver disease Medication stress on liver function
0.6 – 1.2 mg/dL
Infections of the liver such as hepatitis
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH 23
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Why is drug resistance testing important?
HIV drug resistance Determines which HIV treatments your virus is “sensitive” to and which ones your virus is “resistant” to
Resistance testing can: Tell you if your HIV is resistant to any medications
HIV is “resistant” to a medicine if it keeps reproducing even while you are taking it
Help your healthcare provider decide which HIV medications will work best for you and which ones to avoid
Changes (mutations) in the virus cause resistance
If left uncontrolled, HIV can reproduce and lead to AIDS.
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Understanding drug resistance test results
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The importance of HIV therapy
Sensitive = this medicine may work against your HIV
Keep viral load as low as possible
Reduced susceptibility = this medicine may not work against your HIV
Goal: prevent HIV from damaging your immune system
These results should be reviewed with your healthcare provider
Viral load LOW
Increase CD4 cell count HIGH CD4 cell count
Goal: keep your immune system strong so it is able to fight off infections
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Types of HIV medicines
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How do HIV medicines work? HIV medicines slow down the reproduction of the virus at various stages
Four groups (“classes”) • Nucleoside reverse transcriptase inhibitor (NRTI), or “nuke”
Each HIV medicine group fights HIV in different ways
• Non-nucleoside reverse transcriptase inhibitor (NNRTI), or “non-nuke”
Main difference: the stage of HIV reproduction that is targeted
• Protease inhibitor (PI) • Entry inhibitor (also called fusion inhibitor)
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What does HAART stand for?
When you are prescribed HAART Your healthcare provider will combine different HIV medicines
HAART: Highly Active Antiretroviral Therapy
ƒ Goal: most fighting power against HIV with the fewest side effects
A combination of HIV medicines from different groups that are taken together to keep HIV levels down
Your healthcare provider will check your viral load, CD4 cell count and other lab numbers Your healthcare provider may also test for HIV drug resistance
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What you can do Take an active role in treating and controlling your HIV Take the correct dose of each of your HIV medicines every day, at the right time Ask for help if you have trouble sticking to your dosing schedule Š2006 Gilead Sciences, Inc. All rights reserved.
Talk to your healthcare provider about the results of all your lab tests and any side effects you experience
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