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Post Tx with no SVR - What now?
Nov 15, 2007

50, Co-infected HIV/HCV Caucasian Male, Geno 1a with grade 2/stage 2 at start of PEG. Current absolute cd4 480 and LFT's normal 6 months post Tx.

Having relapsed at 6 months post tx what are my options?

Response from Dr. McGovern

What a disappointment!

There are two types of pegylated interferon. I would ask your physician if you were treated with Pegasys which is the interferon that was FDA-approved for the treatment of coinfection. Secondly, I would ask if you received weight-based dosing of ribavirin at 13 mg/kg. If you only received fixed dose (400 mg twice daily) then perhaps this change could make the difference.

However, the most important issue is to also review your virologic response. Did you clear the virus rapidly by 4 weeks, more slowly at 12 weeks, or did you just get a 2-log drop by 12 weeks. This is a critical point, since if you got a 2-log decline in virus by 12 weeks, but didn't clear it completely until 20 weeks, then 48 weeks of treatment would have been too short. I usually aim for 36 weeks of non-detectable virus based on a large meta-analysis.

If you had a slow response, you may be a good candidate for newer therapies in the future. It is unclear as to when we will have protease inhibitors such as telaprevir available to us, but I do believe the more specific STAT-C agents are going to make a huge difference for HIV/HCV coinfected patients. My hope is that the addition of these agents will help patients attain a rapid virologic response, which appears to be the key element that leads to a sustained virologic response.

Best wishes for your health. Hang in there!



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