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thank you D.R barbara
Jun 28, 2009

i want friest to thank you very much for your help and your advices to me . i hope you remember me i wrote to you since one year telling you that i have 3 virus. HIV&C&B . my V.L was not detected and my CD4 was 915 so that i do not take any med for HIV.i began C&B treatment . big interferon 100 for 48 weekes and ribavirin 400 twice daiely for virus C.and zeffix 100 mg one daily. now after 48 weeks my p.c.r is negative(zero) for C and negative (zero) for Band also my HBeAg is negativ. now i have to thank you and want ask you what should i do for C&B&HIV?

Response from Dr. McGovern

It is great news to hear about your viral suppression for both hep B and C. However, I am concerned that you were taking Zeffix (lamivudine) in the absence an HIV regimen since lamivudine also has HIV activity. Taking lamivudine by itself may have led to HIV drug resistance.

The latest HIV guidelines suggest that earlier therapy for HIV may be considered in patients with chronic viral hepatitis on a case by case basis. You will want to discuss this with an HIV expert to see if you should start triple therapy for HIV now. This will depend on many factors such as whether you have been "cured" of your hepatitis C or not (off treatment) and whether you have seroconverted from E antigen positive to E antibody positive status.

I would also get resistance testing for lamivudine to know if you have HIV resistance. You may not have developed resistance if you were on lamivudine and interferon at the same time since interferon may have also suppressed your HIV infection as well. You are much less likely to develop HIV resistance in the setting of complete viral suppression.

So in summary, your news on complete suppression of B and C is great - please see an HIV expert who can further advise you about your next steps in regard to your HIV infection. Since your T cells are so high, I would be very influenced by the final outcomes of your viral infections and your HIV viral load in terms of your overall management. At the very least get HIV drug resistance testing if you have any detectable virus.



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