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interferon and hiv
Dec 28, 2008

I have HIV coinfection with HBV and HCV. Yesterday I got my viral load for both HBV and HCV, and for both it was undetectable after 6 months on interferon 100 weakly and rebavirin 400 twice daily and zefix . I noted that my CD4 droped from 915 since 6 monthes to 436 (35%)since 45 days and yesterday was 213(28%)and my CD8 also 213(28%)and cd4/cd8 ratio 1.

What should i do? I have no doctor in my contry! Can i stop interferon? Would the HCV come back? Please help me quicly as you can and remember me because I have not any doctor to ask him . Thank you very much

Response from Dr. DeJesus

Your case continues to be complex. You must have some guidance there from someone, when you are currently taking interferon and Zefix (lamivudine). Someone is giving you those prescriptions.

Regarding the HBV: the first question is to find out if that HBV infection is indeed active. If it is not active, you do not need treatment for HBV. If it was active before you started treatment with Zefix, then you need to continue this HBV treatment. You will know if it was active, if you had a positive Hepatis B surface antigen (HBSag) and an elevated HBV viral load before you started treatment wit h the Zefix. If you are not able to find out that information, continue to take this medication without interruption.

Ideally, if you are getting treatment for HBV, you should also be taking treatment for the HIV. As I mentioned before, you should not start or take treatment for HBV and ignore the HIV, both should be treated simultaneously (see my previous response for specific recommendations).

Regarding the HCV: the interferon you are taking is treating not only your HCV, but also it is possibly helping to treat your HBV and the HIV, as the interferon has anti-HBV and anti-HIV activity. There is a pill frequently used with interferon for the treatment of HCV called ribavirin (I do not know how it will be called in your country); but you should be on that pill as well for the treatment of HCV.

Regarding how long you should continue the HCV treatment with IFN, it depends on what type of HCV you have (there are different typescalled genotypes). If you do not know your HCV genotype, perhaps it will be relatively safe for you to continue the interferon treatment for 1 year total. So do not stop it now, especially if it's working.

The interferon is know to cause a transient drop on your CD4 cells, so I would not worry about those CD4 or CD8 for now, while you are taking the interferon. They will come back up when you are off interferon.

I am curious about why they are treating you HBV and HCV but not for HIV!



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