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Recently Diagnosed HIV+ and Hep B+
Nov 2, 1999

Three weeks ago I was diagnosed HIV+ and Hep B+. I just got my blood work back from my "specialist" and he is putting me on Combivir and Viracept. I've only had blood work done once and the viral load test done was supposedly an ultra-sensitive test that had a measurement cap of 75,000 copies. My VL results came back above 75,000 but no specific number so I don't know if I have 100,000 or 500,000 copies/ml. He told me this didn't matter since the end result was to get me to undetectable. Is this this a good coarse of action? I start the meds tonight, so if I need to get another VL test done as a baseline I need to get it done soon. Also, he said it appears that I might be a cronic Hep B candidate. How will that effect my HIV? He said more blood work will be done to determine my Hep B status, but that my liver enzymes were above normal. I get my next blood work done in 8 weeks. Thanks for your help.

Response from Dr. Pavia

It is helpful to know how high your HIV viral load really is, at least to know how quickly to expect it to become undetectable. In addition, if it is really high (loosely defined, let's say over 300,000-500,000) its worth thinking about a 4 drug regimen, at least at first, to help get your viral load down fast. This is an area of some controversy though. A second test is recommended, although not always necessary, to really get a true feel for where you are starting from.

The 3TC (epivir) portion of the combivir may work against your hepatitis B. However, I would usually want to know more about your hepatitis B at the beginning of treatment, so we can see if it is working or if it stops working (Hep B virus can develop resistance too!!!). We would usually get an Hep B e antigen and a Hep B viral load. Depending on how your liver is doing, sometimes we will get an opinion from a liver specialist (hepatologist) to see whether to look farther. That might mean getting a liver biopsy if your liver enzymes look worrisome, to learn what is really going on. A liver biopsy usually involves putting a needle through the skin of your chest into the liver to get a sample. Not fun, but not too awful, if it is really going to help. Talk with your doc before starting. If you guys can't talk, that's not a good sign. Good luck.

ATP



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