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HIV / HCV Part II
Apr 5, 2006

Sorry about that duplicate submission; I thought it must've been missed, but they're positing answers to the website in chunks, and of course they got to it about 15 minutes after I'd sent it again!

In response to your response, you indirectly answered one of my questions, but I really want to see a more-blunt answer. In our quarter century of HIV experience, do you believe that everyone will eventually progress to at least a diagnosis, if not necessarily an OI, of AIDS? Over the past 20 years, I've gone from "maybe you'll be lucky and not get sick" to now, "you should have known that this was inevitable". Do I need to cut out the wishful thinking, and presume that my CD4 is going to go below 200 sooner rather than later without treatment?

Along those lines, another question: Dr. is very trigger-happy, and I can see him wanting to stop the Pegasys/Rebrtrol immediately if my CD4s do happen to drop, or even my percentages. I've been subject to the rollercoaster of labs for years; I was supposedly on death's door 15 years ago because my CD4 had gone below 500. So I'm definitely not one to make decisions lightly nor based on one given lab. But my question to you is: would you think it'd be better to push through and complete the HCV treatment rather than abandoning it mid-stream? In response to one of your questions, I'm genotype 3, which as you know has an 80% successful treatment rate. But I'm not even 25% complete with my regimen.

Response from Dr. McGovern

I don't know what is part I of this question, but I will answer based on what I am reading:

I consider HIV a chronic disease as I do diabetes. It is important with both diseases to take care of yourself and to take medications as needed.

As for hepatitis C treatment in HIV infected patients, yes you are correct that genotype 3 is very favorable. I would certainly push on with treatment particularly if you get a good viral load decline at 12 weeks of treatment.

As for CD4 cells: these absolute numbers of CD4 cells will decline on interferon; but the percentage usually remains stable. I only pay attention to the CD4 percentage when my patients are on interferon.

Dr. M



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