My meds and drug-induced anemia.

It's been almost two weeks since I confirmed that I am anemic, and my blood count history shows that it could be drug-induced.

I started taking anti-retroviral (ARV) drugs on July 31, 2012. I started trial on nevirapine (Nevipan) one tablet once a day, and lamivudine + zidovudine (Avacomb) combi twice daily for two weeks. I also started taking isoniazid and cotrimaxazole as prophylaxis for TB and pneumonia, respectively. Before I took the meds, I had a CBC, and my hemoglobin was 140.

After two weeks, I passed the trial period for nevirapine without experiencing the usual side effects. I was happy because most people I talked to were allergic to nevirapine, and I'm glad the first set of meds prescribed to me worked without causing any adverse side effects. So the doctor upped my nevirapine dosage to twice daily, and continued with the rest of my other meds.

After another two weeks, or one month after I started taking meds, I had another CBC. My hemoglobin count was lower at 130, but still ok. The nurse told me that the reason I need to take regular CBCs was to ensure my hemoglobin doesn't drop, because zidovudine is known to cause drug-induced anemia.

Fast forward: October 5, 2012. I went to RITM on an emergency case because I developed blisters on my body. I was also very pale. It's been a little more than two months since I started taking ARV drugs. The night before, I stopped taking my evening dose of nevirapine, because I thought the blisters might have been a side effect of nevirapine. But after seeing the doctors at RITM, I learned that what I had was not an allergic reaction to nevirapine, but herpes zoster, which was possibly caused by a combination of stress, and a weak immune system. Again, I was relieved because I didn't want to change my meds. I was afraid of taking efavirenz, which was the usual replacement for nevirapine.

I also took another CBC that day, and the result was alarming. From 130 just a month ago, my hemoglobin count dropped to 86. The doctor immediately removed zidovudine from my meds and replaced it with tenofivir once daily. He also asked me to take ferrous sulfate help combat anemia.

After 10 days, on October 15, I visited RITM for a checkup on my herpes zoster, which has already dried up, and to take another CBC. As I told in a previous blog entry, my hemoglobin count dropped further to 74. Apparently the effect of zidovudine takes time to wane. All I can do now is to rest, wait, and make sure I eat iron-rich food and take iron supplements to combat the anemia.

I'll be going to RITM again on monday for another CBC. Hopefully I hear good news.

False alarm!

Yesterday I went back to RITM (Research Institute for Tropical Medicine) for a follow-up consultation on two cases: first is for the shingles I contracted 2 weeks ago, and second is for my anemia. I arrived there at around 8:30AM, early because if I were to consult the dermatologist in the afternoon, I need to finish the CBC and HIV doctor consultation in the morning. That was the plan.

However, there was no dermatologist available yesterday, because all of them were in Boracay attending a conference. (These doctors sure know how to mix business with pleasure! :)

So I was left with consulting the doctor for my anemia. I had my blood taken at around 9am and I had to wait for a while before I could get the result. I saw the doctor at 10am and after showing her the already dried up blisters, she advised me to take vitamin B complex to help repair damaged nerve cells. She couldn't help me with my anemia until the lab results were in, so it meant that I had to see her again after lunch.

While waiting for the results, a good friend and fellow patient arrived. Let's call him S. S was confined in RITM for 7 days the week before, also for anemia. I was supposed to give him a visit the last time I was there, but since I had herpes zoster at that time, I couldn't.

He was there to complete some paper works related to his confinement, as well as to get a copy of his medical records. He will be seeing a hematologist at a different hospital to consult if there is an underlying condition that causes his hemoglobin count to continously drop: even after changing meds from zidovudine to stavudine to tenofivir, and after 20 bags of blood transfusion. I was listening to his story intently, because if worse came to worst, I might be in the same shoes as he is.

S is a very cheerful guy. I admire how he is able to keep a strong and positive disposition despite the uncertainty surrounding his condition. He's such an adorable guy!

Around lunch time, we got the result of my CBC. My hemoglobin count is 74. My previous count was 86. Two months ago, it was 130. How can this be? I was feeling a lot better now than I did the week before, it's been more than a week since I stopped taking zidovudine, and I've been resting the entire week. Why is my hemoglobin count still dropping?

Ate Ellen, the senior nurse at RITM ARG, suggested that I might need to get a blood transfusion asap. I panicked. My family doesn't know about my status. I left the house for a casual checkup, how would they react if I tell them I'm getting a blood transfusion all of a sudden?

A huge dilemma is in front of me: is it time to disclose to my family?

S knew what was running through my mind. During lunch, he told me I needed someone to look after me while I was getting the blood transfusion. For that reason I have to contact my family. But, he told me that there is no need to disclose my status to my family. He told me that RITM staff respect their patient's privacy, and they do not disclose their patient's status to anyone, not even to relatives. During the time he was confined there, his family knows that he was receiving treatment for anemia, and nothing more.

This encouraged me to call my family and tell them I might be getting a blood transfusion. But I told them prematurely. They were already preparing to go to RITM to bring my things, when the doctor came in after the lunch break. He told me that if I was feeling better, and I had no signs of anemia (such as shortness of breath, exhaustion, etc.), then I don't need a blood transfusion. Yet. He told me that I need to do another CBC for the next week and see if my hemoglobin count has improved or not.

So it was a false alarm after all! Of course I was happy, and S and the rest of the RITM staff were happy. But I feel bad for having given my family something to worry about. In the first place, that's the reason why I've kept my condition a secret from them all along: I don't want them to worry about me.

So I called my family and told them not to go to RITM anymore. My mom told me she will put ampalaya and chicken liver in the menu. It seems to me they're relieved that I'm not getting a blood transfusion anymore.

So I went home like nothing happened. Today, I had adobong atay ng manok with kamote sprouts for lunch, and had ginisang ampalaya for dinner.

The big news.

I left the testing center with questions unanswered. If I was negative, what caused my illness a few weeks ago. I was unconvinced about the result, and I was bent on taking another test after the three month window period has lapsed.

So, in the weeks that followed, I tried living a normal life. Only that, life didn't seem normal anymore.

As days passed, more symptoms presented themselves. I had recurring sore throat, I had oral infections,  I had sweaty (as in dripping wet sweaty) nights, and lost a lot of weight (from 74kg before I was infected, I was 67kg in March). I was no stranger to the symptoms of HIV infection: I've read them all. And I am absolutely convinced I have been infected.

Last week of March, the three-month window period has lapsed. It was time for me to get another test. I've been planning about the test when by some eerie coincidence, I got a series of text messages and missed calls from the guy I had sex with in December. He was asking, "Kelan ka nagkasakit? (When did you get sick?)" When I was able to respond, he told me a disturbing news: his former sex partner tested positive and asked him to get tested. He said he's been crying a lot and was afraid. I consoled him and told him that we should get tested immediately the following day.

So we did. I went to Manila Social Hygiene Clinic, and he went to a private clinic in Makati. The doctor recognized me and asked, "Dati ka na di ba?". Haha. Yes, Doc. I reminded here that I got tested in January, I was non-reactive, but would like to undergo another test to confirm.

It was difficult to explain how I was feeling that day. The symptoms I experienced, the bareback sex, and the news about another guy testing positive: the signs were all too compelling for me to be too hopeful.

After the doctor came back with the result, the look on her worried face gave me broke the news to me even before she opened her mouth. And then she said it, "Reactive ka na."

Others would have cried after hearing that. Believe it or not, I felt a sign of relief -- I got confirmation of something that I already knew all along. It doesn't mean I didn't feel sad. I did. A little maybe.

The doctor later on told me that they will send my blood to San Lazaro for a confirmatory test and that it will take three weeks for the result to come in. I asked her what are the chances it will turn out false positive. She said the possibility is slim, because I was high risk.

I told the guy about my result. He said, his was the same. He said sorry. I told him no need to say sorry, we're both victims of this disease. I never felt anger. At the end of the day, it was also my fault for not properly protecting myself. He didn't force me to have bareback sex. I agreed to it.

So I went home, feeling a little lonely, with a lot of questions in my mind. What will happen to me? My career? My family? Will I die soon? Will I need to stop working? Should I tell my family? Who do I tell? Where do I find treatment?

I arrived home still confused, but I pretended to smile. I went to my room and slept.

The following day, I felt better. It's like waking up to a new life.

The signs.

Life went on as usual after that casual encounter. As it was nearing Christmas, I was busy. Everyday, there are activities going around to fill your day. I went out to dinner with friends almost every night. I accepted invitations to run a few rounds at a local university campus. I still went to the gym regularly, although I didn't see him in the days that went by. He wasn't a regular of that gym after all.

It has been ten days since that casual encounter. With everything going on around, I got a bit tired and needed to relax. So I went to a spa with a friend. After the massage, I went home and slept. The following morning, I woke up not feeling well. I'm having fever, and my body is aching all over. Had I stretched my body too much? I have been running three consecutive days before that, and been going to the gym regularly. I must be tired, and I feel tired. So I rested the whole day, hoping that I'd feel better in the afternoon. But the fever didn't go away.

I started taking ibuprofen and paracetamol for the the muscle pain and fever, but they didn't seem to work. The fever would go away for a while and come back again, and my muscles are sore. When my lymph nodes began to swell, I knew something was not right. I have an infection.

Five straight days I had non-stop fever, aching muscle, diarrhoea, sore throat and swollen lymph nodes. I've never been this sick before, and at the back of my mind I look back at that bare encounter and ask myself, could this be it?

After the fever has subsided I went to the doctor for a checkup. I wanted to know what was happening to me. Dengue fever was in season, and I was actually hoping that it's what I have. After a series of tests, my doctor couldn't tell. She just told me it could be flu that will go away on its own.

I did get better as the days passed. My muscles weren't sore anymore, and I had no more fever, but my lymph nodes were still swollen. I also developed rashes that looked like insect bites and when I showed it to my doctor, she said it's not how Dengue fever rashes looked like.

Since the doctor couldn't tell what my illness was, I decided to get an HIV test. I had it at the Manila Social Hygiene Clinic in Quiricada St., Manila, just in front of the San Lazaro Hospital. This isn't my first time to get tested so I wasn't afraid. I already knew the procedure and I knew what to expect. I knew that there will be a pre-extraction counselling, and post-extraction counselling. The doctor who talked to me was very motherly and she talked to me very casually. She made sure I felt comfortable. I talked about the casual encounter just a few weeks ago, and the illness I had after. She told me that the result might not be accurate this early after the last encounter, and she suggested I have another test after a three-month window period should I test negative.

After the pre-counselling session, she referred me to the lab to get my blood extracted. The lab was just one level below the counselling room, and it was over within a minute. So I went back to the counselling area and waited there. After fifteen minutes, the doctor called me and showed me the result: non-reactive.

There was a sigh of relief. But I knew I couldn't be certain until I had another test after the three month window period has passed.

On the way home, I called him up. I told him about the test and encouraged him to take it as well. He didn't take my suggestion well. He said, I was non-reactive, so why should he take it? He's not feeling sick after all.

Being the diplomatic person I was, I didn't force him to do it. So I went home, still uncertain, with so many questions in mind. But if there is one thing that I was certain of that day, I was certain that I was not HIV-positive, not yet.

How it all started.

I've been receiving the same messages in Planet Romeo about how I got this. Please allow me to tell you a story that all started at the gym...

I am a gym junkie, at least I was. I go to one of the big gym chains in Metro Manila. I am not hardcore, and I don't have bulging muscles, but I workout almost everyday, and I've built my body just enough to get noticed.

I usually workout in the late afternoons to early evenings for about an hour and a half, hit the sauna for 5-10 minutes, take a shower and go home. That's my routine. But...

As gay gym-goers know, the gym is a huge cruising place. Cruising starts at the training area and ends in the sauna. I am no stranger to that, and I get hit on a few times (okay, more than a few times). I am usually inattentive to flirtations, unless you actually get my attention. I've had my fair share of gym encounters. I am human after all and I fall to temptations.

One day, near the end of my workout I noticed this guy entering the gym. I've already talked to this guy once before in the sauna. Back then, I already knew he was trying to flirt with me. But nothing happened, I guess I wasn't in the mood. So we said our casual hi's and hello's and I continued with my workout. I saw him get started with his workout, but since I was almost done when he arrived, I hit the locker room not long after and hit the sauna. I was just getting comfy in the sauna alone, when unsurprisingly he enters and joined me. We had a decent chat, and nothing untoward happened, so I entertained him. We actually had a good chat, so good that when he invited me out for a drink, I said yes.

We went to a restaurant serving beer just near the gym. There we continued to talk about stuff, and drank some more, and talked again, and drank some more until we were drunk and we were talking about sex. Past midnight, I told him I can't drink anymore and call it a night and he asked if I can go home drunk. (Ah... I knew where that line was going...) Then he politely asked if he can bring me to a hotel just a walking distance from the restaurant where I can rest until I'm sober enough to go home. (Yeah right...). I knew it was coming, I couldn't go home anyways, so I agreed. And I'll be honest, I was horny that night as well, so the possibility of having sex is more than welcome.

So we checked in, took a shower, and hit the bed in our undergarments. A few minutes later, we started feeling each other. Then passionately kissing each other. And we went further... unprotected, unsafe. All my reservations, gone, thanks to a few bottles of beer.

I went home the following morning. We kept in touch through text and I went on with daily routine. Everything was normal until the 11th day.

(To be continued.)

Tingling shingles.

So I was at RITM yesterday, and it's confirmed that I have Herpes Zoster or 'Shingles'.

Herpes Zoster is caused by the varicella zoster virus, the same virus that causes chicken pox. After talking to doctors and doing my own research, I learned that after chicken pox is healed, the virus is never fully eliminated from the body. It hides in nerve cells and enters a latent state, and only reactivates when the person is immunocompromised, such as when taking immune suppressants, going through psychological stress, or when having immune system disorders like HIV.

Since the virus is the same as chicken pox, it is contagious to those who never had chicken pox before, or to those whose immune systems are compromised (if you have shingles, stay away from children, pregnant women, elderly persons, or any persons with weak immune system.) Shingles cannot be transferred to persons with a healthy immune sytem who already have had chicken pox before.

According to doctors, it takes 2-3 weeks for shingle blisters to heal. But the pain could remain for up to six months.

Wikipedia - Herpes Zoster

I'm back!

I was meaning to start this blog months ago to give a detailed account of how I'm coping with HIV. Unfortunately due to time constraints, I haven't had the time to update this blog.

Anyway, The reason why I have time now is because I took time off from work, which needless to say caused me undue stress. I shouldn't have forced myself to go back in the first place! Now my body feels tired all the time, I have rashes that might be herpes zoster or drug allergy, and I might be suffering from anemia.

I'm seeing the doctor today. I promise I'll follow every instruction to the dot.