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Hep B Coinfection, too early to start HBV med?
Nov 3, 2006

Dear Dr.McGovern

I' ve been using ddI+d4T+EFV combination for 5 years. Recent lab result shows VL>50; CD4=572. About last two months, I told my doctor that I also had HBV so he asked for HBV blood testing. The result is HBV DNA 10log, ALT=32, ALT 34, Upper abdomen Ultrasound=OK, Alfa fetoprotein=3.2. So he asked me to take Adefovir Dipivoxil (Hepsera) to reduce HBV viral load. I wonder if it is too early to start HBV med now since the blood result does not show acute Hepa B. (I have ALT and AST testing twice every year and the results never show over 40.) Please kindly help. I'm afraid of HBV drug resistance if I start HBV treatment too early. Sorry for my English.

Justin M. Bangkok, Thailand

Response from Dr. McGovern

I agree with your concerns regarding resistance.

You may want to discuss with your physician whether Truvada is available in your country. Truvada is a combination of emtricitabine and tenofovir. Another combination for your hepatitis B would be lamivudine and tenofovir. I like the idea of two HBV agents together. This way you can switch to these two drugs as the backbone of your HIV cocktail as well (since they have great HIV activity) and keep the EFV (sustiva) going for your third drug for your HIV care.



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