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Acute Hiv/Hbv infection
Oct 17, 2002

If a person was recently infected with both hiv/hbv, (3 months)what would you recommend they do in terms of starting hiv treatment. Do you think a person who was simultaneously infected would have the immune responce to clear the hep? Would implementing Haart right away help the immune system to clear the hep b? This is very important and your expert advise would be invaluable.

Response from Dr. Wohl

Your question is very timely as two drugs that have activity against both HBV and HIV recently became available in the US.

Adefovir is a drug which had been investigated for the treatment of HIV infection but at the doses studied had unacceptable toxicity. However, in lower doses the drug is very effective against HBV and is now approved as an HBV therapy.

Tenofovir is a related drug now approved for HIV infection but that also can reduce HBV viral load.

A few things to think about before pursing therapy. First is that many people who get infected with HBV actually clear the virus by themselves and are therefore in no need of therapy. A clinician can run tests to see if a good immune response to HBV has already been made and, if necessary, whether there the HBV viral load in the blood is detectable.

Ideally, HBV and HIV should be treated simultaneously so as to avoid the development of resistance to adefovir/tenofovir which could complicate subsequent HIV therapy. If I was this individual's HIV doc I would confer with her/his hepatologist and discuss the need for immediate HBV therapy versus watchful waiting. Most people with active HBV need not initiate HBV treatment at once. It may be we would decide to follow the liver tests and CD4 counts for a time before jumping into treatment.

When the time did come to start, a tenofovir and 3TC containing combination along with a third agent would make the most sense. As you indicated, sometimes just boosting the immune system will lead to clearance of HBV but in the scenario you describe in which infection with HIV was recent, the immune system is not so crippled that I would expect a tremendous boost with early and aggressive HIV therapy. DW



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