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when to begin treatment for coinfected
Nov 20, 2004

I've been HIV pos for 4 and a half years and tested positive for Hep C at the same time (double-whammy!). My doctors and I decided to monitor levels closely over the past 4 and a half years and delay treatment for HIV. A liver biopsy (following acute symptoms of hepatitis - jaundice, weight-loss, etc...)in Spring of 1999 showed "moderate" scar tissue. I do not drink and take relatively good care of myself - exercise, eat well). I feel well. My CD4 count has been in the 250 range for the past year and my last viral load was 39,000. I hear conflicting reports on when to begin treatment for "co-infecteds", though recently my HIV doctor and I decided to begin treatment due to some gum problems (HIV periodontitis). The meds have arrived - Sustiva and Truvada - and I'm staring at them. I have been for 2 weeks. Afraid to begin. Seems that most of the comments I read are from people who feel that they may have started treatment too early. I feel fine with the exception of the occasional mouth problems that I currently have under control. Should I wait to begin HIV treatment? Will waiting to begin HIV treatment make the HCV worse? Will beginning HIV treatment make the HCV worse? I don't want to make a mistake because I am aware of the fact that once I start, there is virtually no stopping. Please advise. Thank you.

Response from Dr. McGovern

I understand your concern about starting since this is not just some antibiotic course which will be done in ten days.

However, your T cell count is getting to a place where it is very reasonable to start. HIV disease is associated with faster progression of HCV liver disease. A recent study suggests that treatment with HAART may actually slow this trend down.

You may also want to discuss with your doctor if you have HCV virus in your blood. Once your T cells are higher, it might be a great time to start thinking about treating your liver disease.



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