WHAT SHOULD BE THE TREATMENT APPROACH IN AN HIV COINFECTED PATIENT WITH HEPATITIS B AND RAISED CREATININE? CAN TRUVADA BE THE TREATMENT OF CHOICE?

Good question.

Truvada contains tenofovir and emtricitabine. Tenofovir can cause some renal dysfunction so I would be concerned that exposure to this could actually lead to worsening of kidney function.

On the other hand, if your creatinine rise is very mild and your doctor thinks that you have a kidney problem because of detectable HIV (eg HIV-associated nephropathy), HIV viral suppression may be just what you need. Viral suppression with HIV medications has been associated with marked improvement of kidney function in those with HIVAN. I would also make certain that your urine has been tested for protein and if it is positive, you will want to know the amount of protein lost over 24 hours.

HCV can also be associated with a complication called cryoglobulinemia. I would also want to know if you have cryoglobulins in your blood since this can be associated with some kidney dysfunction. Again, I would also want to know if your urine has been analyzed - this time for red cells.

Also be certain to review any other medications you are taking on a regular basis with your doctor, such as Motrin, Advil, etc...which can be associated with kidney problems when you on a regular basis.