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Clear Chronic HBV even with HIV
Jan 27, 2002

Dr. Dieterich,

Diagnosed Hiv+ Chronic HBV 8/01. Base line Vl 350K CD4 71 4. Liver function ALT and AST 0 before meds, no OI's yet.

Started Trizivir and Viracept Sept 01. Week 5 Vl 755 no k, and CD4 100 6. Anemic 10.4 hem. was low before meds at 12.5. I am a male. Week 16 Vl 924, CD4 180 10. Next labs week 28.

ID doc says I will always have chronic Hep B. I believe I need to clear this or I will eventually die from Liver failure. HIV+HBV+Meds = Death.. Period!

I just started 3tc. Maybe I dont't have the YMDD mutation to 3tc yet. I have read that combination therapy for HBV may be the only way to sustain a response to HBV.

I never miss a dose of meds, ever. 12 hours to the minute. My CD4's will approach 350 tops I think even with <50 Vl.

Can I clear HBV. I think I have to. The car won't run with a dirty filter. I don't want to waste 3tc if I'll need it for an effective combo for HBV. I feel like I'm sending a single soldier to win a battle, but will eventually lose the war.

Any suggestions to rev up ID Doc on sending HBV packing.

Response from Dr. Dieterich

Yes. If you use famciclovir 500 twice per day it will delay the HBV resistance. If you switch from trizivir to 3tc, d4t and tenofovir plus famciclovir you will have 3 drugs active aginst HBV. However I would be sure that you have it first and check e antigen and antibody and HBV DNA by PCR. Good luck! DTD



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