|2nd round of pegylated interferon
Jan 30, 2005
My partner is co-infected with HCV and HIV. He stopped consuming any alcohol when diagnosed 5 years ago, and is responding well to his HIV treatment of Sustiva/Combivir (CD4 > 600, undectable VL). He underwent treatment with Pegatron/Ribavarin in 2003 but was stopped after 16 weeks with <2 log reduction in VL. Because his disease is quite advanced with some cirrhosis, his doc wants him to try a second treatment with Pegasys which has recently been approved on the formulary in Quebec. His time on Pegatron was miserable, especially when he was put on Neupogen as well to treat a crash in his neutrophil count. We have 3 questions related to this treatment: - is there any evidence to suggest that Pegasys is any more effective than Pegatron in co-infected patients? - is there significant benefit to underdoing the treatment again even without a cure? - given his advanced disease, would you recommend ongoing treatment with interferon alone if he doesn't achieve a cure with pegasys?
thanks for your forum, it's always good to know we're not alone!
Response from Dr. McGovern
Since your partner's disease is advanced it may be reasonable to see if he can tolerate Pegasys better. There isn't any data to suggest that coinfected patients who didn't respond to one treatment will respond to another. Neutropenia will still probably be an issue.
If he tolerates Pegasys and ribavirin better it may be reasonable to try therapy 1time for 12 weeks only to see if he has a 2 log drop in virus. However, I would consider the chances low.
There is also no data on whether maintenance low dose interferon would be beneficial to him. However, knowing that the use of Pegasys has been associated with histologic improvement in patients without a viral load response, it is reasonable to consider this option. I would discuss this thoroughly with your provider since there is no clear cut guidance in this area.
Also low dose would probably not lead to neutropenia. Dr. McGovern
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