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herpatitis and HIV+ve
Mar 23, 2007

what is the best way out in a case were one is hiv+ and has heratitis B,where ARV treatment is stopped despite low CD4 count due to the drugs worsening condition of the liver.Please suggest a way forward.

Response from Dr. McGovern

This is a complicated situation.

When a patient has hepatitis B, I do try to continue medications that will suppress hepatitis B virus. I prefer Truvada in the situation when a patient also needs treatment for their HIV disease as well. Truvada combines emtricitabine and tenofovir which are both active against hepatitis B.

I would get an ultrasound, an alfa feto protein, a liver biopsy, and see an expert hepatologist or an infectious disease doctor who are informed about taking care of coinfected patients.

If you have cirrhosis and your liver is decompensating, I would talk to your doctor about referral to a liver transplant program that is doing transplants in HIV patients. Patients with HIV/HBV do particularly well.

If you don't have cirrhosis, I would want to get you on the best hepatitis B regimen possible.



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