HBV & HIV
Probably the best news for HIV patients and individuals at high risk for contracting HBV is that an effective vaccine has been available for about 25 years. Well, if this vaccine is so good, why not give it to everyone? Remember as we mentioned above, most healthy individuals are likely to effectively eliminate HBV infection if they contract it, so they don’t need a vaccine. For these individuals, there are antibodies generated against HBV that can be detected in the blood. So before vaccinating anyone, we must first check to see if they have antibodies, and if so, they are already protected against HBV and don’t need a vaccine. For individuals who don’t have antibodies, three vaccinations spaced over weeks and then months are required. You must have all three to have the most protection. People with HIV disease may need higher doses of vaccine to get adequate protection, especially if they have more advanced HIV disease. For these patients, it may be better to treat HIV for a while to strengthen the immune system before giving the vaccine so that it can produce enough HBV antibodies.
There are several good drugs that are effective in treating HBV. These drugs can suppress the virus to undetectable levels just as the HIV drugs do. Three of the drugs active against HBV are also good HIV drugs. This is very convenient for individuals with both HIV and HBV. These three drugs are lamivudine/3TC (Epivir), tenofovir (Viread) and emtricitibine/FTC (Emtriva). A combination product of tenofovir and emtricitibine called Truvada is approved for HIV disease and is also a great combo for HBV. Adefovir (Hepsera) has modest activity against HBV. Two other drugs, entecavir (Baraclude) and telbivudine (Tyzeka) have potent activity against HBV. Another product, alpha-interferon, also has activity against HBV. This drug with be discussed in more detail in the next article on hepatitis C. Some patients may be cured by the treatment by one or a combination of these drugs.
1) If you have HIV infection, talk to your medical provider about getting tested for HBV and then vaccination. If you do not have HIV but are at high risk for HBV infection (intravenous drug user, gay men, commercial sex workers), you may also want to consider getting vaccinated.
2) If you need the vaccine, be sure to get all three vaccinations
3) If you have HIV and HBV, make sure to treat your HIV and your HBV as well
4) Practice safe sex!!! If you inject drugs, use clean needles or learn to use bleach to clean your works. Seek medical treatment for substance abuse.
The next article will discuss hepatitis C infection with HIV disease.
By Dr. Keith Crawford, BDO HIV Expert
Dr. Crawford received a B.S degree in Biology from Cornell University and a B.S. in Pharmacy from Temple University. He completed a residency in clinical pharmacy at the National Institutes of Health. He earned a doctorate in Pharmacology from the Uniformed Services University of the Health Sciences in Bethesda, Maryland. He completed a post-doctoral fellowship at the National Institutes of Health, studying microbial biochemistry and genetics.
He is currently in the Department of Clinical Pharmacology at the Johns Hopkins University School of Medicine where he develops clinical research studies to improve treatment of HIV infection. He is also on faculty at Howard University College of Medicine, in the Department of Pharmacology.