i need your advise before starting treatment

Question

thank u doctor for all your advises during 2 years . iam on zeffix 100 daily since 2008. i made 4 p.c.r all of them negative zero. my hbe antigen is negative. my v.l not detected.my cd4 387. now i will start my treatment by truvada + efavirenz 600 ? are u agree ? what u can advise me about that? please answer me soon that i can not take that before i hear your opinion. thank u very much.

Answer

If you have been on Zeffix (lamivudine) by itself, and you have HIV infection, I am concerned that you may have developed HIV drug resistance to lamivudine. This is because Zeffix has drug activity against both HIV and HBV. If you have been on 3 drugs for HIV all along, that is a different story. I am not sure by reading your question.

If you have been on Zeffix alone, your doctor will need to assess whether you have developed drug resistance by getting a HIV genotype. The reason this is important is because Truvada contains two active HBV drugs (tenofovir and emtricitabine) which would be great for your liver. However, HIV drug resistance to Zeffix will also lead to HIV drug resistance to emtricitabine - a cousin of Zeffix....That is why I am advising resistance testing, since in effect, you would be going on only two active HIV drugs (eg, tenofovir and efavirenz) if you DO have resistance to Zeffix.