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HEP B Treatement Options for HIV + patient
Dec 1, 2007

Hi all; my brother is HIV+ since 10 years almost. He's is a pretty good shape and takes no meds yet, given his low VL (under 30k) and high Cd4 and Cd8 (32% CD4 and 49% cd8). He's also HEB B +, with a HBVDNA title of 360,000,000. His general liver functions are indicating the liver is suffering. I should add he's drinking definetely too much and doing drugs (mostly cocaine) too. I know his limits so I will help him reducing the amount of alchool but I know it will be impossible to make him stop. Coming to my question he must now start a therapy for hepB even if his HIV numbers would not suggest to start with meds. Interferone is not an option because he will not respect the once a day injection program. Docs are suggesting to go for a combined therapy of Truvada, Norvir and Viread; is this cocktail the best available option or, given the latest development, is there any other available option (single dose per day given the subject)?

Thanks a lot for your comments

G.

Response from Dr. McGovern

Yes you are correct that the first step should be discontinuation of any alcohol.

Pegylated interferon is a once weekly injection, but it needs very careful follow up and his physicians may be concerned about this.

There are limited options for him otherwise. Adefovir is one option, but his viral load is so high, I would not expect it to work.

As for HBV/HIV meds: Truvada has Viread in it so I think you don't have the cocktail quite right. However, Truvada it itself would be a great option since it combines two drugs with HIV activity.

He also should be having twice yearly AFPs and Ultrasounds to monitor his liver.

He should also be vaccinated for Hepatitis A if he has never been infected before.



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