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HAART in Hep B in early stages
Apr 13, 2006

Dear Doctor: I send this case to shared with you. Feed back more than welcome. Best Dr JGC Gender MALE Age 29 YRS Past history (including pathologies justifying actual staging) HIV TESTED IN2004, HERPES ZOSTER 2YRS BACK, NO HISTORY OF KOCHS STAGE I HIV Past treatment (+/- ARV) NIL Physical examination NORMAL/NOT FINDINGS Actual symptoms NOT FIND CD4 recent:340 CD4 nadir: NIL HBSAg:positive ALT NORMAL TLC recent 5600 TLC nadir:NIL OthersNIL Radiological findings NIL Actual treatment: NON We PLAN to investigate: If virus is active replicating.

Question (please precise drugs available when treatment related questions): 1. Is it better to initiate HAART in early stage? 2. IF YES, which protocol do you recommend? We dont have access to Adefovir/Tenofovir.

Response from Dr. McGovern

If the virus is replicating, yes I would be inclined to treat. However, the problem is that using a drug like lamivudine can lead to HBV resistance, so I usually like to combine it with a drug like tenofovir, but you don;t have access to this.

You may also consider no treatment for HBV if his liver disease is minimal. If you do that, be careful after you treat his HIV since immune restoration of his CD4 cells can make his hepatitis B flare up. This is not as dangerous, if his liver disease is mild, but can be very dangerous if he has advanced liver disease.

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