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Hep C & Hiv
Sep 15, 2007

I was diagnoised with Hiv in December 2006 with a viral load of 860,000 and a cd4 count of 280. I went on HIV drugs (kaletra & truvada) and now my viral load is now 110 and my cd4 is 790. I found out the end of Feb that I have hep c geno 1a & 1b with a viral load greater than 5 million. I had a liver biopsy in March and found out I was a stage 3 grade 3, but had no sypmtoms of having hep c. I then had immune reconstitution symdrome with MAC and my neck swelled and I had to have surgery then it swelled on the other side and we are treating with Ethambutonal and Chlarythomicin. It is under control, but they say the bacteria is going to take a while to get out of the system. I saw the liver doc on Tuesday and he said that he doesn't want to treat the hep c just yet because it will lower the white blood count and hinder the healing of the neck swelling. My question is how will know if my liver is getting worse? Is that a good idea not treating the liver? Should I get a second opinion? My alt is asl levels have always been in the 60's, however with the last two blood tests they were high 200's on august 13th, and then high 100's august 24th. The liver doctor said this is normal. I guess I am worried about the liver continuing to get worse while we are waiting for the neck to get better. I am already at a stage 3 grade 3, what would stop if from going to a stage 4 while we are waiting and treating the neck? The infectious disease doc says I should be on the meds for another 5-6 months. Any light you can shine would be helpful.

Response from Dr. McGovern

This is a very complicated situation. The good news is that you are responding so well to your HIV regimen. This means that you are taking the medications with excellent adherence.

You are right to have concern about your liver disease. You have stage 3 fibrosis so I would favor treating you within about six months to prevent further progression.

As for the white count going down, I would simply use Neupogen as a growth factor to help your white cells to increase, if needed.

If your liver function tests start becoming elevated again, you could consider speaking with your physician about starting treatment for hepatitis C since interferon would certainly lead to "biochemical improvement" eg, improvement of your liver function tests, while also treating your hepatitis C.

Your physicians may feel that so much is going on right now that they may want to delay for the next six months. If that is the case, that is probably okay as long as you have your eye on starting treatment within this time period to avoid further progression of disease.

I hope this is helpful.



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