Supplements with HIV & HEPATITIS B

Question

I have been on and off of the hiv & hep b meds for the past two years. I go off because of the increase in my alt / ast counts to unbelievable levels.

Anyway, I know milk thistle is said to lend some protection to the liver and I do take it daily. I also eat dandelion greens and drink dandelion root with my coffee. These are said to help the liver.

I realize most of these herbal ways of treating haven't been tested yet, but I'm trying to help myself, just in case. I hope I'm helping myself and not hurting. I certainly feel better doing so over not doing so and I don't think it's all mental.

There are others I know of, but the daily vitamin, for whatever reason, I cannot tolerate it.

So, should I lay off anything, do something, take a jet place and visit you? Any suggestions?

Thanks

Answer

I am concerned about your story because it suggests to me that you may indeed have underlying liver disease secondary to HBV infection. I would suggest the following:

  1. I would want to get you on two dually active agents as part of your antiretroviral regimen. Your flares can be related to the flares that are seen when HBV infected patients go on active medications or may be part of an "immune reconstitution reaction" when T cells go up...I would be more comfortable in following this flare if I knew how advanced your liver disease is. Which brings me to my second point....

  2. Find a hepatologist or an infectious disease specialist who may help to evaluate the stage of your liver disease. This can be done in combination with a thorough history and physical examination, laboratory testing, and sometimes imaging or a biopsy....The evaluation process will depend on multiple factors.

  1. You will need serial follow-up of your HBV DNA levels to be certain they are declining with appropriate treatment. Your history of starting and stopping HBV active drugs concerns me regarding the possibility of drug resistance.

  2. On occasion, we have used pegylated interferon in HIV HCV coinfected patients who develop recurrent flares of liver function tests when they go on HAART. We have published about our case series in Clinical Infectious Diseases.

I would consider pegylated interferon in you as well if you have another serious flare of liver function tests while initiating HAART. Pegylated IFN is effective in HBV infection although there are almost no data using this drug in HIV infected patients. I only suggest this if you have another serious flare of ALT on other HBV and HIV active agents...

I hope this is helpful to you...Best regards....