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HBV considerations in changing HIV regimen
Aug 17, 2000

Dear Dr. Dieterich:

I am coinfected with HIV(14yrs- VL~2000 CD4~400 almost constant since 1994-never had an OI) and HBV(symptomatic 6yrs- ascites, cirrhosis, esophageal vericies) Have been on 3TC since 1994, added AZT 1997, dropped AZT and added Ziagen, Viramune(lasted only two weeks before discontinued due to rash) and Preveon to 3TC in 10/99. Preveon reduced my HBV PCR to undetectable and my ALT from 400 to 35 but creatinine level went up .06 so drug company cut me off. Genotype shows mutations at V75V/I, M184V, and T215Y. Any new regimen suggestions? Thanks, Atlanta

Response from Dr. Dieterich

Dear Atlanta,

Generally speaking ABC 3TC and Famciclovir all have HBV activity. Would use Fam at 500 BID or TID. If you can get adefovir back 10 mg per day is enough for HBV. Efavirenz is reasonably safe for the liver. I might try ABC 3TC Efavirenz(Sustiva) and 10 mg of adefovir if you can get it. Good Luck! DTD

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