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HIV counseling and testing should be offered to all patients before beginning treatment with Epivir-HBV and periodically during treatment because of the risk of emergence of resistant-HIV-1 and limitation of treatment options if Epivir-HBV is prescribed to treat chronic hepatitis B infection in a patient who has unrecognized HIV-1 infection or acquires HIV-1 infection during treatmentsee Warnings and Precautions5.3
4 mg/kg/dose PO twice dailyMax150 mg/doseas part of a fully suppressive antiretroviral regimen is recommended by the HIV guidelines in patients receiving treatment for both HIV and HBVIndications for the treatment of HBV include a detectable serum HBV DNA with or without a positive HBeAG for more than 6 months and persistentmore than 6 monthselevation of serum transaminases2x the upper limit of normal or moreor evidence of chronic hepatitis on liver biopsyIf the patient is to receive treatment for both HIV and HBVthe HIV guidelines recommend that co-infected pediatric patients 2 years of age and older receive an antiretroviral regimen that contains tenofovir in combination with pfeiffer viagra on line. either lamivudine or emtricitabine as the dual NRTI backboneIf tenofovir cannot be usedanother agent with anti-HBV activity should be used in combination with lamivudine or emtricitabine to assure adequate treatment of HBV infectionEpivir-HBV formulation and dosing are not appropriate for patients co-infected with HIV and HBVIf the patient is to receive treatment for HBV and not HIVthe use of emtricitabinelamivudineor tenofovir without a full HAART regimen should be avoided because of the rapid development of drug-resistant HIV mutationsSome experts suggest indefinite therapy due to high relapse rates.
A Each subject may be represented in one or more categoryb During treatment phasec Comparable to a Grade 3 toxicity in accordance with modified WHO criteriaULNUpper limit of normal.
Available data from the APR show no substantial difference in the risk of overall major birth defects for lamivudine compared with the background rate for major birth defects of 2.7reported in the U.Sreference population of the Metropolitan Atlanta Congenital Defects ProgramMACDPThe APR uses the MACDP as a U.Sreference population for birth defects in the general populationThe MACDP evaluates women and infants from a limited geographic area and does not include outcomes for births that occur at less than 20 weeks gestationOf over 11,000 women exposed to lamivudine in the APRless than 1were treated for HBVThe majority of women exposed to lamivudine in the APR were HIV-1-infected and were treated with higher doses of lamivudine compared with HBV mono-infected womenIn addition to lamivudineHIV-1-infected women were also treated with other concomitant medications for HIV-1 infectionsee DataThe estimated rate of miscarriage for women exposed to lamivudine in the indicated population is unknownThe estimated background rate of miscarriage in clinically recognized pregnancies in the U.Sgeneral population is 15to 20
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