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.

Treatment of acute HIV infection is the recommendation from most HIV specialists. If the regimen included 3TC and tenofovir then the hepatitis B co-infection would also likely be well managed. Data as to whether the immune recovery seen with HIV treatment impairs the immune response to hepatitis B would suggset that hepatitis B specific immunity should not be impaired though there may be some liver irritation related to the HIV drugs and/immune activity in the liver. Usually the elevated liver enzymes are mild and treatment can be continued. Ideally, I would like to see results from a clinical trial to establish whether treating Hepatitis B first and then starting HIV treatment yields better results. The ACTG is planning such a trial using a new hepatitis B agent (though in the setting of chronic established HIV infection). KH