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URGENT, should I start right now?
Aug 31, 2007

Hi, sorry I'm asking you to respond as soon as possible, but I'm feeling anxious about the time sensitivity of the decision I'm making. I'm ending the acute phase of Hepatitis B and I still haven't made surface antibodies. My liver functions have returned to normal only 2 weeks ago, and I experienced the heaviest symptoms around the 20th of June; a doctor suggested that I probably have two to four weeks left to make the antibodies. The Aaron Diamond Aids Research center recommended that I start HIV therapy even though, based on my CD4 counts (avg. 370) and Viral Load, it's not necessary. He thinks that therapy may help strengthen my immune system in a way that might be beneficial to the development of a surface antibody for Hep B. My regular physician didn't return my call and went on vacation so her opinion is unavailable to me. Do you think that the stronger, refortified immune system is worth the risk of starting treatment earlier than I need? I have the prescription and have been just holding the bottle for the last two days, wavering about what I should do. Please, please give me some advice.

Yours: Gabriel

Response from Dr. Pierone

Hello, and thanks for posting.

There is a reasonable argument to be made for starting HAART a bit early in the face on acute hepatitis B infection. The guidelines call for initiation of HIV medications when the CD4+ lymphocyte count drops below 350 so your levels are just above this threshold. Atripla contains Viread and Emtriva as the nuke backbone and these agents have excellent activity against hepatitis B so I assume this is the prescription that you are holding. Best of luck to you and let us know what you decide to do and how things turn out.

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