Nov 22, 2008
i have big proplem and i need your help as soon as you can. 4 months ago i had b.c&hiv my p.c.r was b 23000.c2,34000&hiv only 53 and my cd4 was 915 .i took interferon once weekly for year as doctor said with ribavirin and also zeffix for virus b and i did not take any thing for hiv.after 1 month my pcr for c zero. after 3 monthes pcr of c 18000.why!!that is friest proplem and second now after 4 monthes my cd4 drop on for 436.35%and stil 8 monthes for interferon .what should i do if cd4 drop on again.should i stoped interferon or begening to take medicine for hiv. please help me. thank you.
Response from Dr. McGovern
I am not sure I understand everything correctly. You have been diagnosed with HIV, HBV and HCV and have been treated with pegylated interferon and ribavirin for HCV with a temporary suppression of virus followed by recurrence of viremia. You were also treated with zeffix (lamivudine) for HBV. ?baseline ?result? Now you are going to start therapy for HIV due to a CD4 count decline.
I will first tell you that the decline in CD4 cells is expected on interferon. Your CD4 percentage is probably the same or better. You note a CD4% of 35% which in my laboratory is normal. This probably means that your immune system is doing relatively well.
I would wonder what type of HCV genotype you have. If genotype 1, you should have ribavirin dosed at approximately 13 mg/kg. If genotype 2 or 3 I would suggest 400 mg twice daily. The fact that you broke through on treatment may mean that you needed a higher dose of ribavirin. It is not clear to me with the information I have. However, I would probably delay retreatment right now to address some other pressing issues.
The other thing I am uncertain about is whether you just acquired all of these infections at once or had HIV in the past. The US guidelines now suggest that treatment of HIV can start earlier if HBV treatment is needed as well. I would make certain that you are still viremic due to HBV and would evaluate for possible liver disease. I would treat you with three HIV agents , two agents of which should have activity against HBV. These agents could include tenofovir and emtricitabine (as Truvada coformulation) along with another medication for HIV.
I am concerned that your HIV was exposed to a single agent such as Effix (lamivudine) which is active against HBV - but ALSO active against HIV. You may want to go to an HIV specialist for further consultation and drug resistance testing.
You should also have follow-up of both your HBV and HCV viruses to determine which are currently more active. These complex interactions can change over time.
I hope this is helpful to you.
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