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Hepatitis and HIV CoinfectionHepatitis and HIV Coinfection
           
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Urgent, complicated decision
Sep 9, 2007

Hi, sorry I'm asking you to respond as soon as possible, but I'm feeling anxious about the time sensitivity of the decision I'm making. I'm ending the acute phase of Hepatitis B and I still haven't made surface antibodies. My liver functions have returned to normal only 2 weeks ago, and I experienced the heaviest symptoms around the 20th of June; a doctor suggested that I probably have two to four weeks left to make the antibodies. Dr. Marty Marcowitz at Aaron Diamond Aids Research center recommended that I start HIV therapy even though, based on my CD4 counts (avg. 370) and Viral Load, it's not necessary. He thinks that therapy may help strengthen my immune system in a way that might be beneficial to the development of a surface antibody for Hep B. My regular physician didn't return my call and went on vacation so her opinion is unavailable to me. Do you think that the stronger, refortified immune system is worth the risk of starting treatment earlier than I need? I have the prescription and have been just holding the bottle for the last two days, wavering about what I should do. Please, please give me some advice.

Yours: Gabriel

Response from Dr. McGovern

Hepatitis B usually takes about six months to resolve. If your hepatitis B DNA has cleared, your HBV e antigen has become non-reactive, your E antibody has formed and your liver function tests have improved, I would still be hopeful that your surface antibodies will also form.

The rationale to offer you HIV therapy is to improve your immune system. I understand your reluctance to make this decision since it is a big one. I would first review all the labs I have mentioned above. If all are going in the right direction, I would be encouraged and would probably check one more time.

If you have not cleared, you will certainly have good options for HBV treatment.



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