Question

What are best meds for treating HIV and hepatitis B?

16 September 2014. Related: All topics, Changing treatment, Complications and coinfections, Side effects.

I’ve been on tenofovir + lamuvudine in the morning and efavirenz when go to bed for the last 2 years.

I have HIV plus hepatitis b. Will I replace my night pill efavirenz with some other drug. I don’t have problem with lamuvudine+tenofovir.

What is the best combination to treat both hepatitis and HIV other than efavirenz?

I’m not able to tolerate efavirenz side effects and easily getting raged if someone disturbs me. I’m getting much too concerned with this. Please advise.

Thanks in advance.

Answer

Answer: Simon Collins

Hi

Thanks for your question.

There are two different issues that you ask about so I will answer each one separately.

Firstly, you are already taking the best meds for treating hepatitis B. These are the lamivudine (also called 3TC) and tenofovir. Unlike HIV, these two drugs are all you need to treat hep B. You could also take them at the same time as the third drug in the evening if this would make your day a little simpler.

Secondly, you ask about alternatives to efavirenz. You are describing very common side effects to efavirenz – ie mood changes and interrupted sleep. This should be enough for your doctor to talk to you about alternatives.

You definitely need to include a third drug for treating HIV because otherwise drug resistance will develop to the lamivudine and tenofovir.

The choice of an alternative to efavirenz will depend on which other drugs are available in your country. You might be able to use a lower dose of efavirenz and this might reduce the side effects. A recent study (called ENCORE) reported that a 400 mg dose may be just as safe as the current 600 mg dose, but with fewer side effects.

In the UK, changing to a different third drug would be recommended. This would be to an alternative NNRTI or to a boosted PI (usually atazanavir or darunavir boosted by ritonavir).