>>> Tyzeka has a clear edge with pregnant patients and HIV-infected patients (which you forgot to mention in your latest post) <<<
The HIV issue is curious to me also . The quote from the AASLD guidelines I posted were from an addendum added on to the original document sometime after Feb 07. ( I show the pdf doc creation time as 4/30/07 )
I don't quite understand the rec against using Tyzeka for this indication , especially after the discovery that entecavir was active vs. HIV , but there it is.
Here it is again , with some earlier text :
Special Populations
Co-infection with HBV and HIV
We were also informed of a recent case report in which
the selection of an HIV mutant containing the methionine-
to-valine (M184V) substitution was found during
entecavir treatment for chronic hepatitis B in an HBV/
HIV coinfected patient who was not simultaneously receiving
HAART.1 In light of this report, Bristol-Myers
Squibb has advised caution regarding use of entecavir in
this setting. Although the data is preliminary, we agree
with the recommendations in the cautionary letter sent to
all health care providers.
Thus, until further data are available,
we have revised recommendation #33 to read as:
33. Patients who are not on HAART and are not
anticipated to require HAART in the near future
should be treated with an antiviral therapy that does
not target HIV, such as pegIFN-, adefovir, or entecavir.
Caution should be exercised if entecavir is used
in this setting. Although telbivudine does not target
HIV, it should not be used in this circumstance. (II-3)
ANNA S. F. LOK1
BRIAN J. MCMAHON2
1Division of Gastroenterology, University of Michigan
Medical Center, Ann Arbor, MI
2Liver Disease and Hepatitis Program, Alaska Native
Medical Center and Arctic Investigations Program,
Centers for Disease Control, Anchorage, AK
Reference
1. McMahon M, Jilek B, Brennan T, Shen L, Zhou Y, Bhat S, Hale B, Hegarty R, Silicano R, Thio C.
The Anti-Hepatitis B Drug Entecavir Inhibits HIV-1
Replication and Selects HIV-1 Variants Resistant to Antiretroviral Drugs.
Presented at the 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles, CA, February 2007.
