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how much time do I have left for treatment?
Apr 10, 2005

I am male, 48 years, coinfected since more than 20 years (HCV probably since 25 years), my HIV infection is well controlled by a haart treatment (CD4 usually around 500). My HCV-labs: genotype 1, 3.5mio viral load, ALT and AST usually 2 times over the normal. A recent liver biopsy showed bad results: HAI-score 13 (5+1+4+3) and bridging fibrosis (it says "some bridges of necrosis and fibrosis"). A "response calculator" in the web calculats only a 16% chance of clearing the virus by the pegasys/ribavirin treatment in my case. I decided not to start the treatment, because although I'm chronically exhausted, my quality of life is quite good and I still can earn my living and manage my life. I'm afraid this heavy interferon treatment would not help me, but force me to give up my loved work. Am I wrong? How much time do I have probably until a decompensated cirrosis? Do I have time to wait for new treatments? How probable is it that the interferon treatment, even without clearing the virus gives me some additional time? Thank you very much for an answer, the doctors from my country's health system seem to have no time at all to discuss this with me.

Response from Dr. McGovern

I would strongly urge you to consider treatment.

1. Your liver biopsy shows a significant amount of scarring. 2. Your liver biopys also shows inflammation which concerns me regarding your risk of progressing further. 3. You are doing well on HIV medications and have a great CD4 count. 4. You may do much better on the treatment that you expect and you could always stop if you were doing poorly. Most of my patients finish treatment. It is the uncommon person who stops because of side effects. We see patients often to help them through their side effects at Lemuel Shattuck Hospital. 5. Even if you don't get rid of the virus, your liver will most likely benefit - that is what the studies with follow up biopsies show. 6. The other hope is that interferon will slow down the fibrosis progression.

Dr. McGovern



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