CD4 Fluctuations: RCA

I’m going to fast forward my blog post for today and will do a root cause analysis and drill down what caused the drop in my score. Below is a screenshot of my CD4 trend and I will start with my RCA.

CD4 Trend

What went well? 

Looking at the chart, despite my missed medications from November 2012 to 2013 my score has gone drastically from 4 cells/mm3 to 150 cells/mm3. I have been admitted in and out of the hospital because of Asthma, PTB and Pneumonia that is why I worked very hard to get better and gave up my career to move my score up. Because I followed through I achieved a higher score of 350 cells/mm3 after six months and because I wanted to get out of the risk of getting serious infections,with prayer and hardwork, It increased to 511 cells/mm3 with an undetectable viral load. The consistent positive trend was attributed to my healthy balanced diet, exercising regularly, getting enough sleep, not getting stressed out, not smoking, drinking alcohol in moderation, self control and prayer.

Where did we fall short? 

I have to admit after obtaining a score of 511 cells/mm3 I became complacent, that’s just it. I think, I don’t bike like I used to, I don’t cook healthy foods like I used to, also, there’s a change in my sleeping pattern, I don’t get enough sleep like I used to. I don’t smoke but there were a few instances during the last six months that I was drinking alcohol. Lastly, my stress level has push me over the edge. I just failed to follow through, Why? Why? Why? Because I didn’t have any infection since my T-cells gone up and I forgot that taking my ARV will not do the trick alone. I got comfortable and It was an honest mistake. Nevertheless, this is me taking a a step back and re-evaluating my yesterday so I will do better tomorrow. No one is responsible for this result but me. I am the only person who can turn things around.

What could go wrong? 

After a serious discussion with another ID, Dr.Garcia, he was worried that this could be a possible Antiviral drug resistance. Moreover, the nurse on duty reviewed my discussion with my ID which, I noticed, a new process in place during consultations, which is good actually since it was sort of a pep talk discussion and Q&A about my life being an PLHIV. She reiterated that I have to get back on track and follow through if not do better on what I was doing before in gaining a higher CD4.

What’s our plan of action?

I didn’t panic but I took my ID’s message very seriously, they both said if it is a drug resistance my last option with RITM would be to switch to another ARV and if all else fail i’m on my own, either I have to go to Thailand or another country and buy my own meds that would cost around P18,000. That is not an option for me for now so I can’t be HIVDR.

He recommended me to have Genotypic testing that will cost around P4,000 which will not be covered by Phil Health but after clarifying this matter with Mara of ARG-Phil Health we’ll have to wait for the Viral load result. If my VL will result to detectable then we will proceed with Genotypic testing and will be covered by my Phil Health. Mara said that it is normal for CD4 cells to fluctuate especially in my case since I started at a very low score. I doubted what she said so I did a quick Google search and according to this site “Your CD4 cell count can naturally fluctuate, and factors such as having a viral infection can affect it. Don’t put too much emphasis on a single test result. Rather, look at the trend in a number of recent CD4 cell counts.”  If that is the case I should not worry about the drop, the trend still looks pretty impressive, but we will proceed with the Genotypic testing as soon as my viral loud comes out before December.

My Take away: 

Like what I mentioned in my blog post here, I saw this coming. Lord, i’m still grateful that I am still alive, please help me get through this, can’t do this alone. I learned a great deal from this aftermath. Surprisingly, I don’t feel sad, I feel motivated and challenged to prove myself to do better and start working silently. Due to this reason, effective immediately, I will stay away from all activities that will compromise my health.

My health is my priority, this is non negotiable.


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