|HIV + Hepatitis B
May 31, 2010
Hello Dr. I was diagnosed with chronic Hepatits B and HIV six months ago, and my doctor decided for me to start on Atripla. I've been taking the drug for three weeks now, but seems that my Hepatits B symptomps increased. I had hepatic tests done, and my transaminases increased as well as the viral load (in March it was 3,200 copies, now, 33,600 copies). I'm worried, is this normal?
| Response from Dr. McGovern
Hepatitis flares with increased ALTs can certainly happen in the initial phases of hepatitis B treatment. I agree with your doctor that Atripla is a good choice for your HBV and HIV infections. I would expect that your viral load will eventually decline to non-detectable. Sometimes when HBV flares, the viral load goes up before it comes down.
I would let your doctor know if you are developing right upper quadrant pain, nausea or vomiting. I would also get blood tests to look at your liver's synthetic function (INR and albumin).
As a first step in evaluating your liver, your doctor may want to get an ultrasound to evaluate your liver and spleen. Whether you get a liver biopsy will probably depend on if the liver function tests trend downward or not while you take Atripla.
I suspect that things will quiet down but you need very careful monitoring of your blood tests to be sure. Your baseline viral load is low so I am very hopeful for full viral suppression. Take these medications with great adherence daily. This is the simplest regimen there is for both HIV and HBV infections.
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