Does HCV viremia depend upon the immune competence of the host to enable its replication? In someone HIV/HCV co-infected, is HCV viral level generally higher or does not really matter...do the higher HCV levels make it tougher to cure in co-infection, or is it the damaged immune system that presents the challenge for cure in HIV/HCV co-infection? Thanks...

You have posed several excellent questions.

It has been observed in multiple studies that it appears that the HCV RNA load is higher in coinfected patients than in those with HCV alone. So it seems that the immune system may be important in controlling the level of virus.

This level of virus is important since treatment efficacy is based on getting that viral load down to non-detectable levels. Obviously this is harder if you are starting from a higher level. However, the level itself never discourages me from trying. Every individual is different and I follow viral loads on treatment to evaluate the patient's individual response before pre-judging the situation.

Dr. M