Dear Mr.Young, I'm an HBV & HIV coinfected 31 years old male.HBV has been found in my body about 19 years and HIV has just been found positive.CD-4 measured 15 days ago was 534. Should I start treatment now? what kind of medicines do you advise? Thank you in advance and happy Chinese new year. Regards

Alexei Kazakhstan

Privet and thanks for your post from Central Asia!

There are a number of parameters that dictate when (and what) to start treatment for HIV and hepatitis B. First, it should be established if you have circulating HBV or just have antibodies to the virus. The later condition suggests that your immune system has cleared the infection and therefore, HBV would not impact HIV treatment decisions.

Second, persons with active HBV should be evaluated for and when appropriate, be vaccinated for hepatitis A and should limit alcohol consumption.

Third, the extent of HBV disease should be evaluated. There are recent US-based guidelines for management of opportunistic infections that include information about hepatitis B (on page 75).

If you meet criteria for starting treatment for HBV, then we'd typically start an antiretroviral regimen that included tenofovir and either 3TC or FTC (usually with either a NNRTI or protease inhibitor). These three drugs have activity against both HBV and HIV. Once treatment is started, one should be mindful of the possibility of initial immune reconstitution reaction or liver inflammation.

I hope that this is helpful, BY