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hepb + hiv
Sep 30, 2007

I'M COINFECTED SINCE 2004 hiv + hep b e antigen positive, I don't need drugs yet to treat my hiv (cd4 640, viral load 2100) is adefovir the best option for me? my liver biopsy results: fibrosis 1-2 out of 6, inflamation 3/18.

thanks very much for your help!

Response from Dr. McGovern

You ask a very important question. I consider the liver health of HIV infected patients to be an urgent question. All HIV infected patients should be tested for Hepatitis B and C.

The goal of HBV treatment is to suppress the virus. In patients with E antigen positive status an additional goal is to hopefully get "seroconversion". This means that you lose your E antigen and seroconvert to an E antibody positive status. This event usually correlates with less active disease and lower levels of virus.

An important issue to bring to everyone's awareness of is that entecavir - which is a potent HBV drug - should not be used currently in patients with detectable HIV RNA. This is due to the fact that entecavir may have some anti-HIV activity (demonstrated in some case reports of a few patients) which could compromise the effectivenss future HIV treatment regimens.

In your case there are two choices: adefovir, which is less potent than entecavir, but is still effective over time, including patients with HIV. The other choice is pegylated interferon - there is little data on the effectiveness of this drug for HBV treatment in HIV infected patients. There are also many side effects. However, in terms of seroconversion, pegylated interferon is more effective than adefovir in HBV monoinfected patients (about 33 percent compared to 20 percent).

As you can see this is a complicated issue. You will need to discuss the pros and cons with your physician. You will also need monitoring of your HBV DNA over time to be certain that you are responding to therapy along with your Hep E antigen status, alfa feto protein, and ultrasound imaging of your liver. Fortunately, treatment is not urgent since your fibrosis is early stage and your inflammation is mild.



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