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Hepatitis and HIV CoinfectionHepatitis and HIV Coinfection
          
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Can You Please Answer
Aug 20, 2008

Hi, this is the second time I'm asking this question, this is very important and I would really appreciate an answer. My husband is coinfected with HIV (Undetectable) and Hep C. He's been through treatment twice for Hep C, the first time with Peg-Intron & Riba (11 months),the second time with Pegasus & Riba (7 months) Had to stop early due to heart bypass surgery. He's been off Hep C treatment about 5-6 years now. Just saw his Hep C doctor and he wants to put him back on treatment, his liver numbers are very high. He's going to do Infergen, 3x a week. My question to you is, is this a wise or safe option? Can he get back on treatment if he's taking heart medication? And if he can do Infergen, and he relapses,could this buy him some time to try new therapies that are in the pipeline? Can you please take the time to answer these questions. I'm worried and scared. Thank you.

Response from Dr. McGovern

You have asked excellent questions. I am not the best person to give advice since your husband's case is quite complicated and I am sure there are details that are guiding your doctors in their decisions, which I don't know.

I will tell you a critical piece of information that is needed. If your husband had a non-detectable viral load on Pegasys and Ribavirin, but his therapy was prematurely stopped due to the heart surgery, I would simply favor going back on that therapy. If he has genotype 1 infection, I would also be certain that his ribavirin dose is optimized.

The cardiologist on your husband's case should be in agreement to proceed. If your husband has not had problems tolerating ribavirin in the past (eg, no severe anemia) this should be a good sign to proceed.

The hope is for a sustained virologic response. And yes, even if he relapsed after treatment, most studies have shown that interferon does cause improvement in the liver health. However, this improvement is mainly sustained by cure - not temporary suppression.

The other important issue is that being on HIV medications is also important for his liver health. A recent study showed that fibrosis of the liver slowed down in patients who have suppression of HIV.

I hope this is helpful to you.



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