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Apr 2, 2006

HIV+ 20 years; <50, 7 years HCV >700,000


pre-2004 - >325 5/04 - 310 5/05 - 211 7/05 - 270 1/06 - 230

% have been >19

Question #1

Dr. alludes that, irrespective of the lack of a raging HIV viral load, HIV's very presence is wearing upon you over the years, and thus declining CD4s were inevitable. To wit, the notion that my being treated should have been presumed to be inevitable, even after 20 years; thus that "everyone will have AIDS eventually". Without being naive, I would like to think that we don't really know what every long-term non-progressor may or may not do, and as another expert said in another answer, everyone's biology is different. But Dr. seems to think it's a faîaccompli; is it?

Question #2

Another thought bandied about by other medical professionals is that my heavy HCV load may be aggravating my CD4s, and that if I could kick HCV it might help in the long run. I am undergoing a second round of pegintron, this time with ribavirin. My thinking is simply that I agree I do have an obvious problem with HCV and want to try to get it taken care of; while Dr.'s rationale is to "get me ready" for those "inevitable HIV meds", which apparently several of the popular ones work better without coinfection. What are your thoughts on heavy HCV viral load vis àis declining CD4s? Might my CD4s improve if I'm able to achieve a sustained response to the HCV regimen this time?

Response from Dr. McGovern

You ask several excellent questions.

1. Your HCV viral load is high, but I usually see viral loads in the millions.

2. HCV viral load does not correlate with disease. However, I am curious how advanced your liver disease may be. You did not mention your genotype or your liver biopsy results. I have seen many patients with biopsy proven cirrhosis who have "discordant" low CD4 counts with stable CD4 percentages. I think this is related to splenic sequestration of white blood cells which then leads to lower CD4 counts. However, I believe the CD4 percentages are more accurate in this case since these numbers are not effected by changes in white blood cells.

3. Also keep in mind that interferon leads to lower white blood cell counts as well, but the T cell percentages stay the same or increase.

4. I think treatment of your HCV is appropriate, but would have gotten a liver biopsy to know how much disease you have.

5. I agree that treatment of your hepatitis C will be helpful in the future when you do need HIV medications. A healthier liver can break down the needed medications better.

6. There is conflicting information about whether HCV has an effect on T cells and the response of T cells to HAART.

Best of luck. I hope you get good results. Dr. M

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