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Non progressing HIV with chronic HBV
Nov 27, 2000

Doctor,

I discovered in the last year that I am HIV positive, the result of exposure from over 15 years ago. My viral load has continued to be under 4000 for the last year and my cd4 at around 650-700 with no drugs. I have been classified a Long Term Non Progresser and am not currently treating the HIV. I also have HBV which I have known about for some time. My HBV DNA is currently 13900 pg/ml. I have stage 3 fibrosis and my last levels were AST 67 ALT 98 and Bilirubin normal. The HBV seems to be more of a threat to me than the HIV. I was on Epivir for 1 year(prior to knowing about the HIV) and after initial good results broke through. I am seeing both a liver specialist and an HIV specialist who have concurred that I should go back on Epivir(which I have) and then go on Inteferon within the next few months. I have a demanding job and young kids(thank goodness unaffected) so the side effects of the inteferon scare me. Can I be treated with pegolated interferon? Would this make a difference? How would you treat in this case? Your suggestions/response is appreciated.

Response from Dr. Dieterich

What I normally do is to treat with interferon first for 2 months to sensitize the t cells. Peg will be easier to tolerate, although there is no data yet for HBV. At two months I add lamivudine at 150 twice per day plus famciclovir 500 2-3 times per day. In your case using lamivudine monotherapy would not make me happy because of the HIV. I would give you combivir(AZT and 3TC) and famvir with the interferon. The liver disease does sound severe. Good luck and good health! DTD



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