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Statistics and me
Dec 1, 2007

I'm 44 years old, HIV infected in 1998 but only diagnosed in 2000. I'm not on any meds, exercise daily, don't do drugs, quit smoking in 2003, and the little alcohol I used to drink (2-3 beers on Saturdays) are history now, based on my Dr's adivice. No problem with that. My partner died in 2004 of unrelated causes and since then my CD4 count has gone down from over 500 to 240 and the percentage from 22% to 13%. I live in Germany now. Last week I tested positive for HCV. A blood test was done yesterday to identify the type. While awaiting results, my Dr. is discussing with leading specialists on HIV-HCV treatment to decide whether start with Interferon or with HIV meds. What I've read about HCV in HIV patients is not too encouraging: unlike non-HIV patients, the HCV cannot be eliminated, and the progression rate towards cirrhosis and mortality is faster. Questions: 1. Can I do both therapies at once? 2. If I start Interferon, which may help increase my CD4, what are the statistical odds that my body can get rid of HCV in the standard period? 3. If I start with HIV meds to bring my number into a better level, and then start Interferon, won't that be too long, having passed the acute state to a chronic one, reducing my chances to beat the HCV? 4. I'm sure there have been many cases like mine to establish a pattern. Based on that, how long do HIV patients live after diagnosed with HCV? I know nothing is definite, but would like to get some numbers. Thank you for your patience.

Response from Dr. McGovern

I can't tell from your information if we know that your HCV is acute - eg, acquired within the past six months or so. If that is what your physician thinks, then I would get treatment as soon as you can since there is a narrow period for treating acute infection. Even in the setting of HIV, patients respond well when treated acutely with PEG/RBV.

You did not state during what period of time your CD4 counts changed so dramatically. This precipitous decline makes me think you got infected with HCV around that time. I have seen these kind of changes in T cells with acute HCV.

If you have been infected more than six to 12 months ago, then I would first start your HIV medications (avoid DDI and AZT) for about 4 to 6 weeks to determine your side effects. You can also wait for your CD4 counts to rise further if you desire, although the level of the count has not been strongly linked to response.

I have had many patients with good results. I would emphasize weight-based ribavirin for genotype 1 infection; I would also emphasize excellent adherence with your medications.

Best of luck to you.

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