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Doubt and Fear on C Treatment
Oct 20, 2006

Hi. HCV and HIV+ male 46 years old I'm on HAART terapy since April 2002. My viral load at first test was 190.000 and cd4 240.Start the first regime with Sustiva Videx Zerit and i took this meds for two year after two year stop zerit to switch Epivir for lipo, but VL go never undetectable, although my doctor put me on resistance test for two time with negative responce. My cd4 after the first month of terapy go up 329 and VL go down to to 923. For tree years with this terapy my VL was always fluctuating never <50 but around 2000 with peak to 6000 and cd4 around 400 > 571 max.My terapy aderence was honestly on 97/% for side effects of Sustiva that no go fade away. The firsts month on this med there was very hard for me, but my doctor say me that swith to another NNRTi like Viramune was no good for my Hepatic situation and change to an IP idem but to sparing it for my future terapy.At present from June switch to Reyataz 300mg plus 100mg norvir booster plus Viread 300 and Epivir 300. Regarding HCV, my genotype is 4/cd and VL on last test since 02/2005 was >2000.000 ( very high). The first test on PCR HCV was 340.000 about 10/2003.My actual hepatic markers values (06/09/2006) of Got and GPT respectively are 52/70;GGT 464; ALP 234; CPK 76; LDH 216;bilirubin go up to 2,6 for Reyataz interference.My doctor often test me with ECOscan but there are not suspicious damages or focals injury.I have just a little angioma in seven sector.My Hiv VL now is undetectable (<40) and cd4 are 474 Last complete retest (HCV & HIV PCR) I will do it on 11/12/2006 I'm thinking to start the C treatment but i'm very doubtful. My doctor want to do from many times a hepatic biopsy but i dont want this, because I know that genotype 1 and 4 interferon with ribavirin do not responde more than 25% to the terapy therefore a biopsy is unnecessary or vain.I dont know what to do.I'm very scared.I want just a litlle help. Escuse me for bad English

Thanks. Marcello.

Response from Dr. McGovern

Dear Marcello: I can only speak English so I am very impressed that you are at least bilingual.

Your HIV disease seems to be in excellent shape. Genotype 4 responds a bit better than genotype 1. However, the most important thing to know is how YOU will respond. When we quote statistics, they have relate to large groups of people. But you want to know if it is worth it for YOU to try.

I would say a firm yes. First of all, not everyone has bad side effects. Secondly, you will know in about 12 weeks if your chance of responding is very low. If your viral load has not declined by 2 logs by 12 weeks of treatment, you can discuss whether you should continue on with your doctor.

So it is important to give it a try for at least 3 months and then you will get a better idea if you should continue on.



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