Sep 3, 2006
if hep c can be cured,then why is it so hard to treat someone coinfected?wouldnt it be wise to treat hep c first,then hiv?and can someone carry hep c and hiv for more than 12 years and not know?(alivehoping)on the boards
Response from Dr. McGovern
You ask the million dollar question. I will answer with the following:
1. HIV/HCV coinfected patients can be cured. Up to 40% in the APRICOT trial who went on pegylated interferon alfa 2a plus ribavirin developed a sustaind virologic response.
2. Sustained virologic response usually translates into long term "cure", even in patients with HIV.
3. Genotypes 2 and 3 are much easier to treat than genotypes 1 and That is particularly true of coinfection as well.
4. Our biggest problem is with high viral load genotype 1 infection. Several studies suggest that coinfected patients have higher HCV viral loads than patients without HIV. I believe that this is our biggest obstacle.
5. The emphasis in recent HCV trials has been on whether a patient is achieving a rapid viral load on treatment - measured in some studies as early as 4 weeks. The other important time point is the 12 week viral load. This result basically infers whether a patient has little chance of responding at all. These two results tell us very different things. If a patient has HIV and has a very high viral load, this affects both the 4 and 12 weeks results and has an impact on outcome. Should we treat longer? With higher doses of PEG?
6. The other issue is related to ribavirin. Most of the clinical trials have used 800 mg a day in coinfected patients due to concerns about toxicity. The drug appears to be relatively safe so now a study called PRESCO is evaluating whether increasing the dose of ribavirin can help increase response rates in patients with high viral load genotype 1 infection.
7. As for your last comment - order of treatment HIV or HCV... That will certainly depend on the relative stages of each infection. There are no hard and fast rules and I believe each patient is unique and an individual case.
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