Jun 5, 2007
Certainly I don't recommend this to anyone, but fortunately it worked out for me. With the comination of side effects from my pegasys/ribavirin plus my CD4 being suppressed even further while on the regimen (230 -> 100), I threw in the towel early. I had 37 injections, and then four doses of ribavirin after that before I sent up the white flag. Luckily, it was enough for me--my seven month viral load lab is still undetectable. But my question is: why isn't there more study of 36 weeks? What's so special about 24 and 48 (and I guess in some patients, I've even heard of 72). As brutal as the experience can be for some, not to mention the expense, I'm just curious why something in-between is never contemplated. In retrospect, I'm thrilled I bailed and didn't put myself through that additional 11 3/4 weeks; so at least, perhaps I can be a test case for 36 weeks! My AST and ALT have also normalized, and my CD4 has now risen back to 205.
Response from Dr. McGovern
I am quite thrilled to read about your response. But you are right in advocating that not everyone should do this.
Patients with HIV/HCV coinfection have somewhat lower response rates to Pegylated interferon and Ribavirin therapy than patients with HCV alone. However, it does lead to a sustained viral response in about 60 percent of people with a low viral load at baseline who have genotype 1 infection. PEG/RBV also leads to a sustained virologic response in about 65 percent of people with genotypes 2 or 3.
I suspect your great response to only 36 weeks of therapy is related to having either a low viral load to start or having a favorable genotype.
Another thing I would bet on is that your virus was suppressed early on in therapy. In patients with HCV alone, we are learning that 36 weeks of non-detectable virus while on therapy seems to be associated with the best outcomes.
Congratulations! 36 is your new lucky number.
Also talk to your physician about the prevention of HCV.
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