Hi, Barbara, thank you for your time. What treatment would you recommend for a person who is hiv undetectable, has 450 cd4, with chronic hepatitis b, also undetectable, who is taking nevirapine and combivir?

Since you have undetectable HIV RNA, HBV DNA and great CD4 counts, I am not sure you need any changes in your medications. However, I will say that the DHHS guidelines do suggest the use of Truvada as part of your HIV treatment regimen in patients with active HBV. Perhaps you did not have any detectable HBV DNA in your blood from the start. You may want to ask your doctor about that.

Another important point is that lamivudine (which is part of combivir) is an active HBV drug. However, HBV can often become resistant to lamivudine. However, resistance does not develop in someone who does not have viral replication. If you continue to take your medications well (as you are obviously doing already) then I think you should do great because you have no detectable virus.

There are some data that show that nevirapine can cause liver toxicity. But this usually occurs within about 8 weeks of starting treatment. Since you have been on these medications for a long time, it seems like you are doing well. You should have liver function testing regularly.

If you are HBsAg positive (which I suspect you still are), you should also have twice yearly AFP testing (a simple blood test) and ultrasound testing, even if your HBV DNA is suppressed.