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HBV is detectable, again
Mar 23, 2007

My HBV vl was undetectable (below 100) 12/06; popped up to 200 1/07. My Doctor is very concerned and has prescribed Telbivudine , which the insurance has yet to agree to pay for. I have the samples, yet to take them until I know I can continue the drug without interruption.

My question: what is the likelihood that the undetectable reading was false?

3/06 my HIV vl was 85; HBV vl 27 million. last sept the numbers dropped to undetectable and 4,600 respectively. My CD4 147 (highest since diagnosis in Jan '06). Thanksgiving time everything was undetectable and my CD4 dropped to 110, and one month later my HBV popped up to 200, CD4=90. Liver enzymes are normal.

I have been taking Atripla for the past year in addition to Bactrim DS (daily) and Zithromax (1200 mg) 1/wk.

Response from Dr. McGovern

Atripla has three medications in it, two of which are drugs which has activity against HBV - emtricitabine and tenofovir.

I would not have added a third hepatitis B agent to Atripla. Also if you have become resistant to emtricitabine, you would also be resistant to telbivudine since these two drugs have the same HBV resistance profile.

I wonder if the latest HBV level is misleading and perhaps your next test will be more reassuring. Most patients who take combination therapy for hepatitis B do great.



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