Question

Co-infected with hepatitis B and hepatitis C, when should I start HIV treatment?

14 May 2010. Related: Access to treatment, All topics, Complications and coinfections, Drug interactions, Starting treatment.

In June 2008 I found out I was positive for HIV, hepatitis C and hepatitis B. I was cured of the hepatitis C using interferon therapy and I am still negative for hepatitis C one year after the end of treatment. I have also been cured of hepatitis B by using treatment with Zeffix (lamivudine, 3TC) 100 mg 1 tablet a day. I have now been negative for hepatitis B for 2 years.

I have not yet started HIV medication. My CD4 T cells decreased with interferon and then rebounded again until they reached 636 for 5 months and then dropped again to 362 about 2 months ago. Today I have a CD4 count of 387 (22%).

I want to know what is happening and what is your advice? Especially since I am from Egypt and do not have a doctor who specialises in this situation? Should I start HIV treatment? And what is the proper treatment for my case? Should I wait and start treatment later? Is it possible to generate more T cells?

Please reply fast. I am 22 years old. Thank you.

Answer

Answer: Charlotte Walker

Thank you for your question.

It is good to hear that you have managed to clear the hepatitis B and the hepatitis C.

It is very usual to see a CD4 count drop when taking treatment for hepatitis C and then for it to increase again once the treatment is completed.

Current recommendations state that HIV medication should be started when your CD4 count gets to around 350. As you CD4 count is now 387, this means you should begin to think about starting HIV medication in the next few months.

One very important thing to note is that once hepatitis B treatment has started, unless the infection is completely cleared the treatment should not be stopped. Stopping the drugs for hepatitis B can cause serious problems with your liver.

The treatment you are taking for hepatitis B is actually one of the drugs against HIV as well. You should not really be taking this drug on its own if you are also HIV positive. It probably means your HIV is now resistant to the Zeffix (lamivudine). If you were in the UK, in this situation you would probably be started on tenofivir and emtricitine (FTC) which is often taken as one pill called Truvada. Both of these compounds work on the HIV and hepatitis B. This would be taken with a boosted protease inhibitor.

For more information about HIV and hepatitis C co-infection please read the i-Base ‘Guide to HIV and HCV Co-infection’ and more specifically the section on hepatitis B co-infection

For more information on starting medication then please follow this link to the i-Base ‘Introduction to Combination Therapy’ guide.