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Length of treatment
Oct 20, 2006

Hi Dr. I first want to say thanks to all of the Drs. on for answering some of my questions. I have HIV and HCV (1a). It is so hard to get my GI DR to answer my questions and when he does the answers are always short with no explanations. I had an appointment last week before he sent me to have a liver biopsy. I asked if I would also be getting another viral load done to see if it had cleared on its own in the last 6 months that my HIV DR has been getting my HIV to the undetectable point. He told me no that he thought that it was not going to clear and that I needed to start treatment as soon as my biopsy came back.I have had only one viral load check and the amount was 1,360,000IU. My biopsy came back today and the nurse told me that the results were stage 1 and the cirrhosis was stage 0.She said that that was great news, and to be glad. My first question is should I get a second opinion or demand another viral load count before I start this treatment? Secondly, during my visit I asked him how long this treatment would last and he said usually he wants to treat people with coinfections of HIV for 1 1/2 years if the treatment was showing signs of it working. Everything that I have read on this web page and others all said 48 weeks if it was working.How long would you recommend treatment? I was all ready to go for the 48 weeks, even with the poor % of positive outcomes. I was ready to give it a try but now 1 1/2 years seams to be more than I can fathom.I have watched my outlook go form I am ready to fight this to I don't know if I will be able to make it through 1 1/2 years of all of the side effects.I am already on Paxcil CR for depression and I know that I should be happy over my biopsy results, but I am now more depressed then ever. What would you do?

Response from Dr. McGovern

Don't despair. It is GREAT news that you have so little scarring. That is something to be really happy about.

Yes I think it is reasonable to try a trial of treatment. You have about a 1 out of 3 chance of getting a sustained response and that is pretty good. The latest data suggests that weight based ribavirin seems to be safe and effective in patients with genotype 1 infection (ICAAC meeting, San Francisco 9/06).

Furhtermore, you can see how you are doing at 4 and 12 weeks. If you do NOT get a 2 log viral load decline by 12 weeks, then I would stop therapy since you have mild disease and it will probably not work.

As for duration of treatment - most of the current data is with 48 weeks. The ICAAC study showed that many people could not continue with longer treatment than 48 weeks.

hepa b active

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