Q and A

Question

I have been treated for hepatitis B – what HIV medication should I take?

I have on Zeffix (lamivudine, 3TC) for two years to treat my hepatitis B. I have now cured hepatitis B. I am due to start HIV medication in a few weeks. They want to start me on Truvada (tenofovir and FTC) with efavirenz (Sustiva). I want to know when I start this medication if I should stop taking the Zeffix or not?

Please answer me soon. Thank you.

Answer

Thank you for your question.

Truvada contains FTC and tenofovir, both of which also work to treat hepatitis B. This means you do not need to continue with the Zeffix especially if your hepatitis B has now been cured.

If you have been taking Zeffix (lamivudine) without any other HIV medications then your HIV is likely to be resistant to this drug now. Lamivudine and FTC (one of the drugs in Truvada) have similar resistance profiles. This means that the HIV is probably also resistant to FTC. If you take Truvada and efavirenz then you will only have two drugs that work on the HIV. This may still be ok, as some research suggests that this resistance (called M184V) is less active.

HIV can become more easily resistant to efavirenz (Sustiva) compared to a boosted protease inhibitor, if the combinations does not include three active drugs. So starting your HIV treatment with Truvada with efavirenz could cause resistance problems in the future.

Talk to your doctor about combining the Truvada with a boosted protease inhibitor instead. It is harder for HIV to become resistant to protease inhibitors and so this combination will be a more effective option in your situation.

2 comments

  1. Charlotte Walker

    Please see a full answer to this question by following this link.

  2. ahmedmero

    Thank you for your answers.

    Doctors who specialize in this condition do not exist in my country. I’ve been positive for 3 viral infections at in the same time, HIV, hepatitis B and hepatitis C since July 2008. I didn’t treat the HIV because when I first tested my CD4 count was 915. Instead I started to treat the hepatitis C with interferon and rebavirin for 48 weeks and also began to treat hepatitis B with Zeffix 100 mg per day.

    My viral load tests for hepatitis B and C have now been negative for two years. M CD4 cells decreased with interferon and then went up again after I finished the treatment reaching a CD4 count of 636.

    Just one week ago my CD4 count fell to 387 T cells (22%). Yesterday I went for a viral load test and the results will be ready next week. The government doctors made a mistake when they started treating hepatitis B with Zeffix and now they nearly made a mistake of trying to treat the HIV with Truvada & efavirenz.

    I hope you advise me of the optimal treatment for my case? I am 22 years old all the special labs for liver and kidney function and fat and blood picture are all good. Waiting for your response. Thank you.

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