Hello,
thanks for the query

Amongst the various tests you have done, the ones that really present with worries are the CD4 count, liver function tests ( aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and gamma glutamyl transferase).

Am worried about the CD4 count (even though you did not state the initial value or previous values) because after such a long time on antireviral (ARV) the value is still at 322, Even if you had values that were lower than this, after this long time on the drug, just at 322 implies there is a problem that has to be addresses.
Concomitant opportunistic infections such as tuberculosis or other immune deficiency induced diseases, poor nutrition etc could cause a poor evolution.

The liver function tests do not look good, they are more in favor of an ongoing inflammation of the liver that must be investigated upon. Viral hepatitis, alcohol intake, drugs and severe infections of blood or sepsis could caused these abnormalities and should be investigated upon.

Virotrenz is a combination of three anti-retroviral drugs namely; emtricitabine, tenofovir and efavirenz. All drugs have side effects. Effavirenz is known to cause liver problems and it is likely that it is the effavirenz that is causing the increase in liver enzymes.

You need to XXXXXXX your doctor for detail examination, ruling out of possible opportunistic diseases, and for an evaluation of your treatment plan which i think is not working due to therapeutic failure or that you do not adhere to treatment correctly. If there is failure, your drug regimen would have to be change completely. The substitute for effavirenz is nevirapine which also causes liver problems and thus it is likely that your drug regimen would be changed completely since i assumed you are type 1 HIV positive.

Hope this answers your query. If you have further query, i will be glad to respond.

Best regards

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Hello,
thanks once more for the query,

Its a great thing that you finally decided to move on, i assure you, its going to be different from on; the depression, stress and anxiety and even the poor CD4 would be over as you will be more devoted and determine to see yourself healthy.

Like i said in my first mail, alcohol affects the liver and together with the effavirenz you, there is increase effect of liver damage. However, the degree of liver damage can not be over emphasized now but then there is already a liver affection. You need to stop alcohol and certain drugs like paracetamol or acetaminophen. Cigarette is a terrible toxic substance and it destroys the body drastically. It predisposes to almost all types of cancers in the body and the fact that your immune system is being weakened by the HIV infection makes you more susceptible to the effects of cigarette.

Your kidney function tests are normal and there is no lesion or visible lesion as of now following the results of your renal functions.

The initial symptoms you felt when you started virotrenz were due to efavirenz which is a component of the three drugs that make up the virotrenz. but then symptoms improve with time as you rightly noted.

Intake of the drug is better on an empty stomach, at least 4 hours after a meal ( due to the presence of efavirenz) so as to improve on absorption. You should correct this.

It is difficult to conclude if you have a resistance now or if the poor rise in CD4 is due to poor in take technique ( poor absorption) or other causes such as opportunistic diseases or due to a type 2 infection that requires different regimen plan.

SO what i will advice is that;
-stop alcoh0l
-stop smoking
-eat balanced diet
-maintain high hygienic standards and XXXXXXX your doctor for re-evaluation

Hope this answers your query. If you have further query, i will be glad to respond. If you do not have further query, you could close the discussion and rate the answers.

Best regards

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