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Initiation of therapy in HIV/HCV conifection.
Dec 1, 2007

I had a + HCV serology in July and at that time had blood drawn for a PCR, which came back +ve. I was only informed in November and not by my doctor but by a public health nurse. When I called for an urgent appointment I was scheduled 5 weeks later. My LFTs have been consistently normal since my acute HCV illness 2 years ago. Are normal LFTs a good or bad prognostic indicator wrt HCV liver disease? My HIV infection has been under control for 10+ years with undetectable viral load and normal WBC/CD4. Other than the many side effects associated with Interferon + Ribavirin Tx, is there any reason for which my doctor did not inform me of the results of PCR immediately, change my HIV meds from Trizivir to Atripla to reduce the risk of anemia associated with Interferon, and why he seems in no rush to initiate HepC Rx or for that matter even assess my viral load or determine what genotype(s) is/are present?

Response from Dr. McGovern

I would recommend getting a HCV RNA and a HCV genotype to determine something about the baseline viral load and type of HCV that you have.

If you have viremia (virus in your blood) I would proceed with a liver biopsy to see if you have any liver disease, even if you have normal liver function tests. Patients can have disease even in this situation.

There is no need to rush to treatment. I think it is more important to determine if you need treatment in the first place.

In about three to five years I expect that we will have other therapies to add to Interferon and Ribavirin that will also make therapy more effective. If you have no disease, it may be reasonable to wait.

I am also happy to know that you are doing well with your HIV medications. There is some information that suggests that suppression of HIV is also helpful to the liver.



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