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i want understand my case
Feb 26, 2010

i had 3 viruses since 2008 C&B&HIV . i hhave finished my corse for C with interferon & ribavirin for 48 weeks and my p.c.r is negative(zero) and also i still taking zeffix 100 daily sice 18 monthes for virus B and my p.c.r is negative (zero). my hiv till now not detected without med. my cd4 drobed on interferon but now incresed to 636 (24%). i want to understand my case because we do not have specialest hiv doctors in my country. i want to know what kind of lab should i do? what meds should i take in my case when my cd4 drobed? please help me to understand every thing about my case. very thanks.

Response from Dr. McGowan

Great news that you have successfully treated hepatitis C. If your Hep C Viral load (PCR) stays undetectable for at least 6 months after you completed treatment you will be a "sustained responder" which is essentially a cure.

For the hepatitis B you are on zeffix (lamivudine) which is working for now, but there is often breakthrough over time. This drug also works against HIV but must be combined with other active drugs to be effective long-term. Since you are using it alone for the hepatitis B it means that your HIV will certainly develop resistance against it. However the drug (or a similar one called emtricitabine) should be included in your HIV treatment in order to keep the hepatitis B suppressed.

Even though your CD4 count is good, because you are needing treatment for hepatitis B with zeffix, it would be best to consider treating your HIV now as well. The treatment would best include a combination of tenofovir + emtricitabine (truvada) both of which will treat HIV and hepatitis B (be sure to check with your doctor that you have normal kidney function first) + 2 (two) additional active medicines for HIV (since there will be emtricitabine resistance); or truvada + a "boosted" protease inhibitor" (such as Kaletra or Novir + Reyataz or Prezista).

Best, Joe



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