Letter Sender 3: ARVs and Travelling

Hello guys! 

It's been a while. I haven't checked my mail in what feels like eternity and am quite surprised to see a few messages from blog readers. One of them came from a reader from Malaysia, and here is his message:

"Hi thr. I come across ur blog while researching for upcoming trip. 

Am plhiv from kl. Malaysia. On haart since sept last year. Currently cd4 above 500 n vl undetectable.

I need to travel to swirtzeland on end of nov. Am not worry about immigration or anything. Just i need your advice since am on combivir and efavrinze cocktail.

Combivir for twice a day 8 am 8 pm. And efavirenz at 11 30 pm. When i am bout to go to bed.

My question is when u travel. Do u take med according time of ur origin country i e malaysia. 
If i follow time in msia i need to take the med on 2 am 2pm and 5.30 pm swiss time. 

It will be bit difficult since u know efavirenz can makes one bit drowsy n sleepy. 

One doc suggest if u travel less than 2 weeks just follow malaysia time. Some senior plhiv said if u healthy n stable just follow swiss time. He has been doing it for so many times n ok.

But am afraid about interruption on meds since willl b pn board for almost 16 hrs. 

Any ideas. Since i think i ll be okay with taking tih swiss time but a bit confuse worry i will prolong time for efavirenz once i touch down on zurich.

Any ideas. Thx so much for ur support."

Here was my reply:

"Hi there,

My deepest apologies for my late response. I have not checked this email for a long time, and I'm surprised that I have quite a few enquiries!

My response may not be relevant to you anymore, but I will share my opinion nonetheless. 

One of my doctors told me that if I were to travel to a place of a completely different time zone, I should follow the local time in my destination. This is for adherence. I've been told that the reason they instruct their patients to take their meds at 8am and 8pm is because these times coincide with activities we do in our normal daily routine (e.g., going to office, having dinner, etc.) which makes it easier for us to remember that it is time to take our meds. 

I also take my meds twice daily, at 8am and 8pm, same as you do. Right now, I'm in Europe, and if I were to follow the local time, then I would have to take my meds at 2am and 2pm, which was difficult to adhere to. So what I did was I took it the same time, as per normal in the Philippines, on the plane, and until the day I arrived at my destination. Then I adjusted taking my meds to 8am local time the following day after I woke up.

So when I travel, if the time difference is not too much, say an hour or two, that will not interfere with my routine, then I take it the same time I do at home. But if there is a huge difference, then I use local time in my destination.

Again, these are my opinion based on my personal experience and my doctor's advice. Please seek your doctor's advice because we have our own peculiarities."

Cheers!

HIVPlus4Plus

Travelling for PLHIV.

One of the most common questions among those newly diagnosed is this: Is travelling abroad still possible?

The answer would really depend on your destination, your purpose of travel and the visa requirements for the country you are travelling to.

There are only a number of countries with strict ban against PLHIV. But most of the ban is imposed only to immigrants or to those securing a work visa. If you are travelling on social or short-term visa, testing for HIV is usually not required in many countries.

My work requires me to travel frequently, even to countries with strict ban against PLHIV. I guess I'm lucky that HIV testing is not required for the short term work visas I apply for, but I do still worry sometimes - what if the time comes an HIV test is required?

Keep in mind that as long as immigration authorities do not know about your status, there is no issue, even in countries which ban PLHIV like Singapore. So it is important that they don't find out about your status. So when you travel, look and be healthy. Don't travel if you are not well. Looking sick might catch the attention of immigration officials. Many airports also have sensors to catch those with fever, and being quarantined is the last thing a PLHIV could wish for.

But what about the medicines? Won't they find out? In my experience, they won't. My bag has gone through countless airport scanners, and I was never asked about the meds I carry, which is quite a lot. But I bring a prescription along, just in case they do ask. I also put them in pillboxes and labeled clear bottles, to make them look more like maintenance medications. They don't usually mind maintenance meds.

I remember my first time going to Australia after I was diagnosed, and the immigration form asked if I was bringing in drugs. I declared yes, and the immigration officer asked, "What type?" To which I replied, "Maintenance meds." She let me through without further questioning.

I also had the courage to send an anonymous email to Singapore's Health Ministry if there would be any problem with me, an HIV-positive individual, going to Singapore on Social Visit with my meds. Their reply was that I can bring up to three months' worth of medicine, as long as these medicines are not in the list of controlled substances in Singapore. Thankfully they weren't.

Here are the countries I've visited so far after I've been diagnosed: Myanmar, Malaysia, Indonesia, Thailand, Singapore and Australia. I've brought three months' worth of medicines to these countries, so if you are PLHIV and are planning to visit these countries on social or short-term visit visa, then worry no more. 

However, if you intend to find work, or even immigrate to another country, it may not be as easy. Each country has its own rule for PLHIV. You may consult http://www.hivrestrictions.org for country-specific restrictions.

Once you are in the country, try to stay healthy. You don't want to be in any situation where they may require your blood. Deportation is possible in some countries if they find out about your status, and I've heard of horror stories from those who got deported.

Have a safe trip!

New Twitter Handle.

Hello dear readers and followers of my blog! Did you miss me? I know it's been a while since the last time I updated my blog, and I would like everyone to know that I'm all good and well. Buhay pa po ako. Hehe.

I've been quite busy this year, with work mostly. So what's happened to me since my last update? Hmmm, let's see...

First, my primary doctor, Dr. Mark Pasayan, is finishing his fellowship at RITM soon and he said he won't be putting up clinic in Metro Manila. So with heavy heart (*sob*), I transferred to Dr. Manolito Chua. Dr. Chua is one of the most senior consultants at RITM so I know I'm in good hands.

Second, my cocktail was changed back to the original Nevirapine-Lamivudine-Zidovudine combo. Yes, zidovudine. The one the we suspect caused my anemia. How did this happen? Well there was a big issue about ARV supplies early this year, and there was a shortage of Tenofivir. It was so bad that medicine refills were done weekly in RITM, and even daily in Makati Med! Since I'm out of the country most of the time (yes, my work requires me to travel a lot), getting my meds on a weekly basis was not an option. So Dr. Chua put me back on trial with zidovudine, which started on May 10, 2014. And guess what? My hemoglobin was steady, even up to this day after 6 months. So perhaps it wasn't really zidovudine that caused my anemia, huh?

Third, my CD4 count last June 1, 2014 went down again from 329 to 260. Big drop. So I had my viral load taken. The result took almost three months to be released, but thankfully my viral load was still at undetectable levels. Baka stress lang sa work kaya bumaba. Or maybe it's an effect of changing meds? Definitely I look forward to seeing my count move up next January, because if it drops some more, I'd be worried.

Lastly, I changed my twitter name, in case you want to follow me. It's now @ako_si_mister_B. So add me up!

Nevirapine vs Efavirenz in improving CD4 count

I had my CD4 count last January 7, and it's now up to 329 from 224! Yey!

My cocktail is nevirapine, lamivudine and tenofivir. Since I had my first CD4 baseline test, my CD4 count has improved from 179 to 233 to 224 to 329. My partner S is also on the same cocktail as I am, and his latest count is 377. His baseline CD4 count is 173 and it has improved to 234 to 317 to 313 to 377. What I noticed, based on the improvement of me and my partner's CD4 count over the past two years, is that nevirapine is slower in bringing up CD4 count, compared to CD4 count improvement of fellow patients on efavirenz. Of course, other factors could affect the increase in CD4 count, but my observation is that those taking efavirenz have greater improvements in their CD4 counts in a shorter amount of time, compared to those taking nevirapine.

Is there a study that proves this? To my fellow pozzies on medication, would you agree to my observation, or disagree?

A look back at 2013.

Another year is nearing its end, and a new one is about to begin. It's the time when we look back at the past to reminisce and ponder on the what-has and what-has-nots, and look forward to the future filled with hope, aspirations and excitement.

This year is one year I will never forget. Whereas 2012 is a year of struggles and uncertainties, I will remember 2013 as the year I fought the battle with HIV... and won. The war may be far from over, and I know there are still more battles to come, but this year, I proved to myself, and to everyone, that there is life after HIV diagnosis. A better life.

Career. After I got diagnosed, the first question that popped into my mind was, "Pano na yung trabaho ko?" I am an OFW, working in a country that bans PLHIV, and I am the breadwinner of the family. I cannot lose my job! That time, I had a lot of fear, and a lot of questions ran in my mind: Should I disclose to my employer? Should I resign before they find out? How would I travel with my ARVs? What if they find out? But soon after, as I went through my daily life, I realized all those fear were just products of my paranoia - similar fear i experienced before i got tested.

I was on indefinite medical leave for 6 months - with pay. Other companies will waste no time firing you on medical grounds if you go on leave for that long, but the company I was working for was very compassionate. My boss was not asking too many questions, and he didn't pressure me on going back to work unless I'm ready.

I'm very thankful just for being able to keep my job, but God showered me with blessings. This year alone, I got several pay raise, and my workload has also gone down a bit. I am also given more vacations back home, which means I get more time to relax. My CD4 are happy!

Lovelife. I think I've written enough about my lovelife in this blog and on twitter that I'm beginning to sound cheesy! My year started out on a sad note with my breakup with J, but it ended with a bang with S.

J and I are now good friends. Just last night, S and I had dinner with him and his new boyfriend, who is also a good friend of mine, along with R and his boyfriend. I don't feel any grudge towards J for what happened between the two of us, and it's a fact of life that relationships start and end. He will always have a special place in my heart, for being there during the time I needed someone the most. I am also thankful to him, because my short-lived relationship with him was the catalyst to the development of my relationship with S.

S and I are now going stronger. We're bestfriends and lovers put together. We supported each other when we were both suffering from anemia. He was my best friend and confidant when I was still seeing J, and after J and I broke up, my relationship with S moved up to another level.

Our relationship is not perfect. We argued a lot. We've broken up countless times. When we officially became a couple, we broke up the following day, making it the shortest relationship I've had. EVER! We argued so much that one time, we even blocked each other from social media.

S and I may have our differences, and we may argue a lot, but these only make our relationship grow stronger. When we argue, we get to know each other a little better. Only when we know each other do we understand each other, and only when we understand each other that we learn to compromise.

To S, you are God's blessing to me. I love you.

Friends. This year, I met a lot of friends. Many I met at RITM, and many more through twitter and PR.

Worth mentioning is R. He is quiet and is the perfect representation of what a lurker on twitter is like. But he's always there when S and I need a friend. When S and I argue, he's the first person we go to. When S and I blocked each other on social media, he mediated so we can talk and make up. To R, you know who you are. Thank you for being the best friend for S and I. You are the best! We love you!

Another worth mentioning is D. I met him through PR, but he's also in twitter now. I still haven't introduced him to S, because he is still uncomfortable coming out. He is a very good listener and I can tell him things I wouldn't normally tell another person. To D, thanks for the friendship and more years to come!

Also worth mentioning are friends who visited me during my confinement in January this year: blogger/doctor K and chef/nurse JR. We may not be in touch as often as we would like, but you guys are some of my closest poz friends!

Of course, I won't forget my friends at RITM: Dr. Pasayan, Ate Ellen, Nurse Roldan and Mon and his mom!

Health. I've never felt healthier! My body hasn't gone back to it's old form, but hey, I haven't been working out as much either. My annual checkup last June revealed that my hemoglobin is back to within normal range, as well as my serum creatinine, xray and sputum. My CD4 count can still be improved at 224, but the best news is that my viral load is now considered undetectable! Yey!

I thank God for the gift of love, wealth, friendships and health. When I thought I was about to lose everything, You gave it back to me tenfold. I give all these back to You. May You guide me to become a better person, a better son, a better brother, a better friend, and a better lover. All in the glory of Your Name.

The Story of S and I.

August 24, 2012. I was on trial for nevirapine for almost 4 weeks then, and I had to go back to RITM for a refill before my meds ran out, and to get my first-month CBC required for those taking zidovudine.

It was a Friday. I knew there will be a lot of people in RITM so I went there early. When I arrived, I got my number, had my CBC request form stamped with OHAT (to get it done for free), and went straight to the clinical lab for blood extraction.

It was a waiting game after that. I had to wait for the result of the CBC before I could see a doctor and get a prescription. It wasn't my first time in RITM, so I knew that it's likely for me to stay there the entire day, and I was mentally prepared to wait.

That time, ARG was still in one of the rooms at the basement of the building at the back. We were supposed to wait there until our number was called. Perhaps out of boredom, I left ARG and went up to the consultation clinic to follow up on the result of my CBC. I was walking along the corridor when a guy standing in the corner in front of the clinic caught my eyes. 

He was not easy to miss, it was a narrow corridor after all. In fact, it was more difficult NOT to notice him. He was wearing a bright yellow, bodyfit t-shirt, and he was using a white jacket to cover his hair and his neck like a scarf. But the jacket was not enough to cover his handsome face, and his tshirt hid little of his toned body and beautiful skin. What a turn on! He was a magnet to my eyes, until I realized that he was also looking at me! Being the snobbish person that I was, I quickly turned my gaze away from him and walked straight into the clinic. After I went out, he was no longer where he was standing, to my disappointment. I didn't see him  anywhere even after walking around and back to ARG, so I thought he might have already left. Haay, wala na si pogi.

So I went back to my business of waiting for my CBC result. Boredom kept me moving around. I couldn't stay long inside the ARG waiting area. I'm suplado, I admit, introverted and aloof, and I don't feel comfortable engaging in small talks.

So i went back, again, to the doctor's clinic to follow-up on my CBC. Unfortunately, it still wasn't in. I was about to go out when the door opened, to my surprise: si Pogi! We were right in front of each other, and our eyes met, but the suplado in me took over. I looked away, excused myself, and walked out the door. Torpe!

He went inside the clinic, and I sat down on the benches outside. I told myself I won't lose my sight of him anymore. So I waited. After sometime, I stood, right in front of the door, so that it's me he sees when he goes out.

While I was there, some guys tried to talk to me. I didn't want to be rude, so I entertained them. While I was talking to them, lumabas si Pogi! He saw me, yes, saw me busy chatting with others. Arrrgh! So he went past me and sat at a bench just between the cashier and the pharmacy.

I pretended to ignore him, but kept stealing quick glances. A few guys tried to talk to him where he sat, and he did talk back, but I noticed he was just being nice. I knew because the conversations were short and looked awkward. A few times, I caught him look at my direction, and I wondered, does he like me? I guess there's only one way to find out.

When the last guy talking to him left, I mustered all the kapal ng mukha, and sat beside him. I was very careful. Nahihiya akong madikit sa kanya, but I felt he was waiting for me to make a move.

It took me a few minutes to muster the courage to talk. "Hi, kanina ka pa?" That's how it started. I introduced myself and he told me his name. Let's call him S. We talked, and talked, and talked. I easily got comfortable with him. We talked about our condition, what we do, all the getting-to-know-you drill. And then I felt his arms touch mine. Skin to skin. ODK, we were flirting! I was surprised how fast things went, but I knew the attraction was mutual.

Then his cellphone beeped. He received a text message and as he replied, I knew from the way he texted that it was from someone special. Shet, mukhang taken. I thought, di bale, we can be friends. Besides, I was dating another guy that time. (Dating, yes, but I was still single then.)

We hung out together until I finally got my CBC result. It went down to 130 from 140, but it was still within normal range so I was given three-and-a-half months' refill for zidovudine, along with nevirapine and lamivudine.

I stayed with him even after I was finished. He was still waiting for a companion to finish his business in RITM and he told me I can hitch a ride with them to Alabang.

While waiting, we walked around and went outside, to the hallway going to the canteen. It was raining so we just stood near the steps, and there, the kulitan continued. We started to be touchy, but in a romantic way. It was going well, it felt good. I was happy.

His friend finished his business and went to where we were. Since it was raining, he drove his SUV and picked us up. S was in the passenger seat, while I took the backseat.

I found out that the guy he was with was involved with an NGO that helped pozzies like us, and that this NGO was assisting him. We talked casually during the ride, but the touchy-ness didn't stop. My hand reached for S, and his hands reached for mine. (Imagine this: he was seated in front, while I was at the back. I covered my arms with my backpack so that his friend wouldn't notice.)

It was only a quick ride, full of excitement and kilig. As much as I wanted the ride to last a bit longer, just so I could hold his hands some more, I had to get off in Alabang. They dropped me off in front of Starmall. I said my thanks to him and his friend, and told him I'd text him.

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That's how my friendship with S started - sa kulitan at landian. I knew at the very beginning it won't develop into something deeper, because he was already in a committed, long-term relationship, so I kept in touch with him without expectation. 

After the day we met, we would text only occasionaly. Casual kumustahan, casual good mornings and nyties. He doesn't text much, and few in words. But I already expected that, so I didn't stop. But I also tried not to sound too persuasive.

I guess the friendly texts worked because after a few days of trying, I was able to invite him to meet. (I just arrived from Baguio for a vacation then, and what I actually told him was that I brought him peanut brittles as pasalubong. Aaah, the convincing power of pasalubong! Works like a charm.)

We met at Cash and Carry in Makati. This was exactly 6 days after the first day we met. I have two containers of peanut brittle in my backpack, and waited in front of Mercury Drug. After a few minutes, he arrived - kilig na naman ako! He was wearing a ball cap, and was wearing it backwards, which gave him a boy-next-door look.

We strolled around the mall aimlessly, talking about ourselves and our situation. We talked about our meds. He described his pillbox. He talked about his room. He talked about where he lives. He talked and talked and I felt good just listening to him. I knew it, I like him.

We found our way to the foodcourt and decided to have our dinner there. I forgot what I ordered, but I still remember what he ordered: salmon. How can I forget? As soon as we finished dinner, he started to itch and his face reddened! He was allergic to salmon, and he probably didn't know! He decided to go home after that and was in such a hurry, we forgot about his peanut brittles!

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I left for abroad a few days after that "date" and I didn't manage to see him before I go. But we still kept in touch through whatsapp and facebook. But as usual, we only said casual how-are-you's. I was busy then, and he was, well, his usual tamad-magtext self.

I was away for about a month, when a medical emergency occured, forcing me to go home. I was developing blisters in my arms, and I thought it was nevirapine rashes and a call to Dra. Magayanes convinced me to have it checked.

My bosses were very understanding and allowed me to fly back home the following day. I told S about what happened to me, and he got worried. Then I found out he was confined in RITM, getting blood transfusion for anemia.

I visited RITM the following day after I arrived, not just to have my rashes checked, but also to visit S. Then I found out what I had wasn't nevirapine rashes - I had herpes zoster. I also found out, after a CBC, that I was dangerously anemic.

That's a turning point in my life, and perhaps the catalyst to which my friendship with S deepened. S and I were going through the same trials. (I first mentioned S in my blog entry, "False Alarm!")

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Our relationship has developed into something Friendster can only describe as "It's complicated!". We are not officially a couple, but we are. I love him very much, and I never thought I'd feel the same way again after I contracted this disease. I'd like to thank him for coming to my life, for giving me the inspiration I need, for making me laugh and for laughing at my sillyness, for being there when I need someone, for taking care of me, for bringing me to the hospital, for cooking me dinner, for the love, the hugs and kisses, for the understanding, for the honesty, for being my best friend and for being the partner everybody would be wishing for.

Today, he's back in the province. Wala na namang connection sa Internet. I miss him. I miss you. I'll be back home in a few weeks, and there is no one I'm dying to see more other than you.

Hello, Twitter!

I just realized I have so many things going on in my mind, random, spur of the moment thoughts that seem to lose their relevance the moment I start putting them into blog. My solution? Join Twitterverse, of course! There you can follow my journey through life in greater, HD-quality detail. And hey, it's easier to communicate there!

Follow me: @hivplus4plus

(Thanks to @health_worker5 for giving me the idea. It's how he meets new friends, and although I have already met a lot of great people here I now consider friends, I know there are more out there!)