In the news ... 2007

New Concern for Using Baraclude (entecavir)
to Treat HBV in HIV-positive People

April 11, 2007

Data presented at the 14th Conference on Retroviruses and Opportunistic Infections (CROI) in February 2007 raise concerns about using the hepatitis B (HBV) drug, Baraclude (entecavir), in people also infected with HIV. Earlier laboratory tests had shown that Baraclude did not have any anti-HIV activity, so it has been recommended for use in HIV/HBV co-infected people who choose to treat their HBV but not their HIV.

Recently, however, a handful of case reports of people taking Baraclude have experienced reductions in HIV viral load and the rapid development of drug resistance. The resistance specifically refers to the M184V mutation that is associated with resistance to the anti-HIV drugs Epivir (lamivudine, 3TC) and Emtriva (emtricitibine, FTC). These reports suggest that, despite the earlier findings, Baraclude does have anti-HIV activity and therefore should only be used in HIV/HBV co-infected people along with a full anti-HIV regimen. This is similar to the recommendations for the anti-HIV drugs, Epivir, Emtriva and Viread (tenofovir, TDF)—all of which have activity against both HIV and HBV.

Treating HBV alone in co-infected individuals is more complicated than simultaneously treating both HBV and HIV. However, there are cases in which people choose to treat their HBV while not treating their HIV. Three options are available for people who so choose—pegylated interferon-alpha, Hepsera (adefovir) and Tyzexa (telbivudine). While adefovir does have anti-HIV properties, is not thought so at the dose given as Hepsera. The similarity between adefovir and tenofovir is significant, and it is the reason that there is concern about its use. Tyzexa isn’t thought to have anti-HIV activity, but there are some lingering concerns that its use—without a fully suppressive anti-HIV regimen—might lead to developing resistance. These concerns are highlighted by this latest finding. There are no similar fears about interferon, because it works so differently.

If you have both HIV and HBV and take Baraclude without being on anti-HIV drugs, speak with your doctor about your treatment options. Consider having resistance tests done to see if any drug resistance has developed. If you are co-infected with HIV and HBV and are taking Epivir, Emtriva, Viread or any fixed-dose combination that includes any of these drugs (Trizivir, Epzicom, Combivir, Truvada), extra care is needed if you decide to stop taking these drugs. There are many reports of liver problems in co-infected people who stopped their anti-HIV regimens which included any of these drugs.