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Hepatitis and HIV CoinfectionHepatitis and HIV Coinfection
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Nov 27, 2004

My husband is HIV pos. and has been on peg-intron and rebetol for 48 weeks. Hep C returned within 3 months and his doctor put him on low-dose pegasus for maintainance. However, my husband wanted to take the copegus with it in order to clear the virus eventually. The doctor agreed, but he wasn't optimistic about clearing. My question is, he has been on maintenance for 5 months and then he started copegus with it for 5 months. Next month the doctor wants to take him off everything. I talked to other professionals and they said that is not long enough. He needs to be on combination treatment longer for best chance of sustained reponse. What is your opinion? Thank you so very much.

Response from Dr. McGovern

There are two different issues which you present in this difficult problem. 1. Your husband underwent 48 weeks of treatment with PEG and Copegus and achieved viral suppression but unfortunately HCV came back when the treatment was stopped. The fact that he did suppress the virus though is excellent news and I suspect he did get "histologic benefit" - in other words, his liver probably looks a lot healthier now if we could take a look under the microscope.

2. Your husband is now undergoing "maintenance" treatment. Maintenance refers to using low dose PEG without Copegus for a long-time to hopefully slow down any chance of complications of HCV infection. It must be emphasized that there is no data yet to support this approach although there is great rationale for using it.

Hopefully we will have more information in the next few years about maintenance. I would not expect your husband to clear the virus at this point. However, I want to emphasize again that I suspect his liver is healthier after this therapy and that is the whole reason why your physician was interested in maintenance therapy. "Maintenance" though refers to PEG alone as defined by the large trials currently underway in patients with HCV alone.

Dr. McGovern

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