HIV diagnosis 4/88. AIDS 6/94. HepC gen 1a 9/97. I've been treated twice, the last 2 years ago. Short luck there both times. Labs in June of this year and labs in August demonstrated a twice fold increase in ALT and AST. Ammonia in my system vaulted to three times more than the highest safe level. What are my chances? Anything I can do now to fend off or slow liver failure?

I am sure it was very discouraging for you to undergo therapy twice and not come out with a sustained response.

A few things I would suggest:

1. Stay away from alcohol.

2. Several studies now suggest that a non-detectable HIV viral load appears to be associated with slower progression of liver disease. I would be certain to take your HIV meds with great adherence to keep your HIV virus suppressed.

3. An increase of two-fold of your ALT and AST does not necessarily mean anything about liver disease progression.

4. Ammonia levels are not meaningful unless you are experiencing issues such as confusion. I hardly ever order this test.

5. You may want to consider a liver biopsy if you have never had one before. This would help determine how much liver disease you have. Not everyone develops liver disease from HCV.

6. New drugs for HCV are being developed and I fully expect a new one will hit the market in about 2 years. You will want to ask your doctor if there are any clinical trials in your area that you can participate in the meantime.

7. Get vaccinated if you have not been exposed to HAV or HBV.

Finally....Hang in there!