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HIV & Hepititis B Coinfections concerns and thoughts

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Sinsation:
I was recently diagnosed with HIV as of April of this year and I also have Hepititis B and have concerns about the toxic effects of the meds on the liver. I'd like to know if anyone shares this issue and what your thoughts, concerns and/or personal experiences. I start my meds this coming week. CD4 115 VL 57,000. A bit scared but I know that there is no other choice. It's a risk/benefit situation. So I'm braving whatever outcome, but I know it's better than the outcome of NOT taking my meds. And that's NOT an option!

Thanks in advance for any help with this.

Steve

Matty the Damned:
Steve,

I know that some anti HIV drugs like 3TC have a suppressive effect on the Hep B virus too so there are some advantages for both conditions when you take HAART.

I would think that drugs like nevirapine which have known nasty attitude to the humble liver are a no-no, but perhaps Newt can better answer your concerns.

MtD

newt:
Okay, newt quacks out a few thoughts...

Best standard of care is written up in the BHIVA guidelines on CO-INFECTION WITH HIV AND HEPATITIS B VIRUS INFECTION.  This is a UK document but not much different elsewhere.

In your case, Steve, the going-by-the-guidelines recommendation would be treat your HIV, using the nukes that are also effective against Hep B - tenofovir (Viread) and either 3TC (Epivir) or FTC (Emtriva) - in the combo (Truvada also counts here cos its tenofovir/FTC combined). These plus another drug from a different class, either Sustiva or a PI.  Choice of drug will depend on the state of your liver and your and your doc's preference.  Sustiva may be hard on the liver, but so too can the Norvir used to boost most PIs. Viracept (nelfinavir) is the only PI that can be used unboosted with ease here. 

You don't say if your Hep B is chronic (older than 6 months) or not.  Or active or resting.  Hep B can flare up on starting HAART, so watch this if its resting.  Plus it can sometimes (sometimes) resolve itself, even after the 6 months = chronic window. 

There are other treatments for chronic Hep B to think about, eg Interferon-A.  This website has a section on Hep B.  Decision to treat the Hep B will depend on assessment of the damage this is causing, it may not be indicated. A liver biopsy is a bit of an old-fashioned technique for Hep B evaluation, ultrasound should be sufficient in most cases.

Short version: guidelines suggest starting anti-HIV combo + watching the Hep B & treating as appropriate.

Having had Hep B myself you have my understanding on how crap this can make you feel.

- matt

Sinsation:
Thanks for your thoughts and suggestions guys. As far as how long I've had Hep B, it is chronic as I was diagnosed in 2001. I did consider the Interferon treatmenst but knew of too many reports that indicated not only severe side effects but that it is only about 40% effective in treating the Hep. Although those numbers may be high for some, I don't think I could suffer for 6 months of treatment then having a 60% chance of it not being effective. As far as the Viracept is concerned I'd like to know if that might be an option for me as my doctor is starting me on Truvada/Reyataz/Norvir. Knowing the side effects of the norivir, I'm wondering if the Viracept may be another option for me.

Much Thanks,

Steve

newt:
You doc has chosen a modern PI combo.  Reyataz is kind to lipids in most cases and the booster dose of Norvir is the lowest of any of the boosted PIs (1 x 100mg egg-type capsule). However, Viracept, old though it is, is still useful, esp. if you want/have to avoid Norvir. It is perhaps not quite as robust resistance-wise as Reyataz. - matt

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