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Author Topic: HIV & Hepititis B Coinfections concerns and thoughts  (Read 2537 times)

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Offline Sinsation

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HIV & Hepititis B Coinfections concerns and thoughts
« on: July 09, 2006, 10:22:56 PM »
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

Offline Matty the Damned

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Re: HIV & Hepititis B Coinfections concerns and thoughts
« Reply #1 on: July 09, 2006, 10:38:23 PM »
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

Offline newt

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Re: HIV & Hepititis B Coinfections concerns and thoughts
« Reply #2 on: July 10, 2006, 02:29:30 AM »
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

« Last Edit: July 10, 2006, 02:31:56 AM by newt »
"The object is to be a well patient, not a good patient"

Offline Sinsation

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Re: HIV & Hepititis B Coinfections concerns and thoughts
« Reply #3 on: July 10, 2006, 04:18:12 AM »
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

Offline newt

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Re: HIV & Hepititis B Coinfections concerns and thoughts
« Reply #4 on: July 10, 2006, 02:03:25 PM »
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
"The object is to be a well patient, not a good patient"

Offline CaptCarl

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Re: HIV & Hepititis B Coinfections concerns and thoughts
« Reply #5 on: July 11, 2006, 11:16:16 PM »
Hello there kiddies!! This is your good old Uncle Carl checking in with his two cents worth on the HIV/Hep B coinfection thingy. I have had both for 19 years now, and it's definitely not a laff riot. There is very little info out there as it seems that most research is focused on Hep C instead. This is annoying for me and frustrating for my Doctor. Steve, I know that since your HIV diagnosis is very recent, you're probably feeling a bit overwhelmed by all of it, especially in light of the lack of info. My advice is to take care of the liver by doing all the things that can help keep it healthy for as long as possible, as well as making sure that any meds you take won't beat it up too bad. It does take quite a while for Hep to seriously damage the liver, but the liver is also capable of an amazing amount of regeneration if given a break. I have been on Interferon twice, and yes it really sucks, no it didn't clear the infection. I did 16 weeks of daily injections, 10 weeks off, then 16 weeks on again. The treatmenttook its toll that's for sure. But it did knock the infection down so the the liver was able to repair itself to a certain degree. If required to take it again, I don't know if I would though. I am on the same regimen you are on, and it has worked very well. Before starting it, the viral load for the HIV was 75,000, and has come down to 81. The Hep B viral load was to quote my doctor, " Fucking astronomical." Even though this precise medical term gave me  the idea that it was not good, I asked for clarification. It turned out that the viral load was over a Billion. That maybe explained why I was so tired all the time. And I thought it was just that I work too much. The Hep load is now down to a much more reasonable 100,000. We shall see if the numbers stay good. I just had a biopsy recently, but do not know the results yet. One imagines that It won't be too spiffy, due to the high level of virus for so long. If it's really bad, I have instructed my doctor to remove the liver, have it chrome plated, and use the fucking thing as a doorstop. If and when I find any info that we can use, I'll be sure to post it, after all, we're all in this together, and we need to help take care of each other. Steve, good luck to you, and remember that when you're walking down this road through the haunted forest we all find ourselves in remember that you are not alone. I and others are here for you. It's okay to be scared. ch love to you and all the other kiddies out there. If you need anything, just ask, I'll do what I can.. Carl
The only thing I can do straight is shoot..

Offline Sinsation

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Re: HIV & Hepititis B Coinfections concerns and thoughts
« Reply #6 on: July 12, 2006, 01:20:34 AM »
Wow! Thanks so much for the info guys. It really has helped me get through this tough time. Carl, reading your reply gave me a light at the end of the tunnel, and it hopefully isn't an oncoming train! Meaning, it really did help with some of the issues that I'm going through. If you can go through this for 19 years, with just 2  years under my belt with Hep, then that gives me some hope as to what I'm gonna be facing in years to come. Although it aint all that "spiffy" as you say, I'll get through it knowing there's treatment for it and also that there are guys like you putting it all in perspective. Carl, reading your reply in parts I laughed my ass off. Not at you, but with you! Wow, what a great sense of humor and spirit. So thanks! Ok so here's where I'm at as of today. Tomorrow is D day! It's finally come. The day I start my meds. A little scared, a little nervous. I find myself going over in my mind all the possibilities of what will be. It's funny, I took the four pills out yesterday and today and held them in my hand and told them "I love you, your going to save my life". I kept repeating it over and over looking intensely at them. Someone told me to embrace my fears and send them love, and that's what I'm trying to do. Thanks for all the info, kind words and sometimes witty replies. And yes, we are all in this together and knowing that has truly got me through some rough times. A big smile and warm embrace to ALL!

Steve

Offline CaptCarl

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Re: HIV & Hepititis B Coinfections concerns and thoughts
« Reply #7 on: July 12, 2006, 11:24:38 AM »
Steve, Carl here. Don't spend too much time dwelling on the possible side effects of meds. After all the mind is a powerful thing, and is capable of creating side effects where there might otherwise be none. The only thing that I notice with my combo is insomnia, which I see by the time of your last posting, you might already be a bit familiar with. Just try to adopt a wait and see attitude if you can. I personally have never told my meds that I Love them. I prefer the mire direct method myself as in " I hate you little fuckers and if you don't work, I'm gonna track down whoever created you and bitch slap the motherfucker!" But hey whatever works amigo. When I have had side effects though, I try to remember that it isn't "real" That is to say that what I'm feeling isn't indicative of actual sickness, but just something that is a consequence of the meds. Oddly enough, it actually seems to help most of the time. Remember too, mi amigo, that any side effects won't last forever, usually just a week or two until your body adjusts. For me staying active physically really seems to help. I walk my dogs a lot, and try to continue working to keep my mind off of the crap I sometimes feel. And sometimes yes, I do just stay home and curl up in the fetal position for a few hours, but very rarely. Use your down time to imagine what changes you would make to the world if you got to be in charge. It's a fun little exercise, and all I know is that the lead mines would be working overtime for a while so that I wouldn't run out of bullets.
       I would like to share a personal philosophy of mine with you, that may help, or, maybe I'm just so full of shit that my eyes are starting to turn brown. I don't know, you decide. The philosophy is this:
                When I die, and get to wherever it is that I'm headed, the person waiting there for me is not going to pick up the book of my life, flip through it and say to me. "Gee, Carl. I see here that you have had 11,253 really lousy, shitty days where you should have just stayed in bed. Here they are for you to live over. This time, get it right dumbass." With this in mind, I always try to make the conscious decision to not let things ruin my time here. Time is the one thing you can never have back, and it's up to you to decide how much of it you are willing to spend unhappy or angry, or any other negative feeling. Stay in touch. Carl...
The only thing I can do straight is shoot..

Offline Sinsation

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  • Posts: 23
Re: HIV & Hepititis B Coinfections concerns and thoughts
« Reply #8 on: July 16, 2006, 02:30:13 AM »
Well I did start my meds three days ago and aside from a headache and a little queasy feeling, it seems that I might take to them better than expected. I had my fears about what I've read and of course should just take a wait and see attitude like was suggested. So I did, and now I'm here with a bit of a headache but I think I'll be able to tolerate this. Thank god it's only a headache! I've been trying to keep a positive outlook about everything and I know we have it alot better than some people out there that are suffering in pain and without the help and support of many agencies and people in their lives. I know I'm truly blessed! I know that things really could be so much worse. Just before logging on here and writing this, I was feeling down. I guess expressing myself along with others and knowing that we're all in this together has really helped. Are there bad days? Of course. But thanks to Ryan White, AFAN, my family and poz friends I'm getting through this and I do know how truly blessed I am. For all those who may have "those" days, look around at all the blessings that surround you. If you look hard enough, they're there right in front of you. Thanks for the shoulder guys, it's helped and will continue to help me. Till next time kiddies, much love......

Steve

Offline bobik

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Re: HIV & Hepititis B Coinfections concerns and thoughts
« Reply #9 on: July 16, 2006, 09:15:56 AM »
Hey Steve,

I have been a Hep.B carrier from 1987 till 1994, with epivir (3tc) it got under control completely. I hope meds work as well for you too!

Coen
Coen Honig at Facebook

 


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