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hcv rebound please answer
Jan 22, 2006

Hi Dr. McGovern: I've asked this before, but no answer. I am HIV pos. (undetectable with medication) and also Hep C pos. Went through 48 weeks of treatment with Peg Intron, and within three months virus returned and went on pegasus for 7 months. (Undetectable with treatment) However, due to heart surgery, I had to stop treatment early. Have been off treatment for about 11 months now. Where do I go from here? Please answer. Thank you.

Response from Dr. McGovern

I actually remember this question so I am sorry you did not receive my response.

The main issue is that you DID respond to antiviral therapy with suppression of HCV RNA. This is a key issue. Yes it is unfortunate that you did not sustain that response, but you did achieve suppression while on therapy.

I would discuss with your HIV, liver, and heart specialists as to whether they think you could go on low-dose maintenance therapy (eg 90 micrograms Pegasys weekly). It is very important to point out that the efficacy of maintenance therapy is not known. There are theoretical benefits of staving off decompensation of cirrhosis and prevention of hepatocellular carcinoma. However,this is not proven.

Whether your physicians would want to consider this approach in you depends on the following: 1. Do you have advanced liver disease? 2. Do you have other complicating factors, such as cardiomyopathy? 3. What were your other symptoms on therapy?

It is also important to know that low dose interferon is associated with much less side effects. I would consider giving you regular therapy up front (PEG and Ribavirin) until you reach a nondetectable viral load and then switching to maintenance PEG alone.

However, your personal doctors know the best course of action because they know your entire medical history - which I do not.

Dr. M



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