Dec 1, 2007
i have been coinfected with hep B and HIV...According to my tests i dont need at the moment to treat HIV but i need to treat hep B because of a high viral load...i am from Greece so my doctor there put me on entecavir treatment (its been a month now)...since i spend some time in the states i was advised by two doctors here too...the one aggreed that entecavir is the right treatment and says that although there is some data about anti-HIV action of entecavir and possibilities of developing resistance for some HIV treatments , still at the moment i should be concetrated in hep B treatment(have a beginnig stage of chirrosis) and that i should not worried about the possible resistance for HIV meds because i will have many other options especially in a few years that new anti-hiv drugs will come out.... Now THE OTHER doctor insists that entecavir is the wrong choice and that i will have much better results with TRUVADA and the added bonus that i will treat both hiv and hep B at the same time(says he has excellent results with patients on TRUVAD)AND I WILL GET UNDETECTABLE VIRAL LOADS very soon for both.... please let me know your opinion and suggestions about all that...thank you in advance...Tony
Response from Dr. McGovern
When I have a patient with cirrosis and hepatitis B, I consider treating both HIV and HBV infections. I would treat both for all of these reasons:
1. I think your response to therapy would be more rapid with dual therapy than with monotherapy and would want your virus to be completely suppressed, especially with cirrhosis.
2. I would not want to give you dual therapy for hepatitis B with Truvada since then your HIV may become resistant to two wonderful and safe drugs. Entecavir puts you at risk for developing resistance to Lamivudine for future HIV therapy - this is a safe and wonderful drug. I do not buy the argument that there will be many other drugs for HIV down the road. Resistance compromises future options.
3. I would give you a combination of HIV medications - like Truvada (tenofovir and emtricitabine combined in one pill) with another drug, like Fosamprenavir dosed for liver disease. This is one drug where the dosing for liver disease is well worked out. This way you treat both infections.
4. Finally I expect the HIV treatment guidelines to change within a few months. I expect we will be seeing recommendations for earlier treatment for HIV. Keep yourself posted. This is another reason I would push on and treat both infections.
5. I would also be getting AFP and ultrasounds every six months.
6. Guidelines for the treatment of HIV/HBV from the USPHS will be coming our shortly as well. I am one of the authors.
Best of luck to you. Hope you get to your beautiful country one day!
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