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HBV and HIV coinfection treatment
Nov 3, 2012

I was diagnosed almost 6 years ago being HIV positive and nearly 15 years having being diagnosed with Hep B. I have never been on any treatment for either as my liver enzymes are still within a normal range and my T Cell and VL counts after HIV diagnosis in January 2007 have been in the range where treatment wasn't necessary until my recent Oct 16th visit when I was told my TC is now 483, VL 228,000 percentage 34.3 and I should start treatment. I am concerned about the medications effect on the liver and other organs for that matter. He wants to begin me on Atripla. Can you advise if this medication or any others I could take to combat the coinfection successfully?

Response from Dr. Taylor

I agree fully with the recommendation to start Atripla, for several reasons.

Having chronic hepatitis B along with HIV infection is now considered an important reason to take HIV medications, no matter what the level of your T cells (CD4+ cells) or HIV viral load, and no matter what the level of your liver enzymes. So ideally everyone with both hepatitis B and HIV should take HIV medications. The hepatitis B disease course can be more aggressive in the presence of HIV, so having good control of both viruses through the use of medications is beneficial to your health.

The goal of taking hepatitis B medications is to drive down your hepatitis B viral load to an undetectable level. Achieving this lowers your chances of developing serious liver disease and/or liver cancer.

Atripla is overall a liver-friendly regimen and is the first choice for people with both HIV and hepatitis B infections. The 'trip' in Atripla is for triple, meaning 3 medications are included in this once-a-day pill. Two of the medications, emtricitabine and tenofovir, are active in fighting both HIV and hepatitis B. The tenofovir is our most effective medication against hepatitis B. Emtricitabine and tenofovir are processed through the kidneys, not the liver. The third component, efavirenz, is in general a safe medication for people with hepatitis B, although monitoring your liver enzymes when taking this medication especially when you start can be important.

Regarding your HIV infection, based on your HIV VL and TC I agree that it is time to start treatment.

For women who could become pregnant, it is important to talk with your doctor about Atripla before starting.

It will be important to take your Atripla as prescribed and to work with your doctor to develop strategies so that you do not miss any pills once you start. Work with your doctor to monitor for any side effects, but again I consider the benefits to far outweigh any concerns.



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