Nov 16, 2008
Dear dr.Barbara,I am HCV/HIV coinfected.No need for HAART therapy,CD4 450,but i would like to start interferon/ribavirin treatment.HCV genotype1.I know that my chances are not great with this(and only)therapy for now.Do you think that I should start treatment anyway or I should wait for new kind of therapy for HCV?Thank you very much.All the best.Jovana.
Response from Dr. McGovern
Excellent question. Many different issues to address:
1. I would want to know your baseline viral load. If less than 400,000 IU/ml, the chances for a response are still quite high despite your genotype 1 infection.
2. I would want to know how much disease you have on a biopsy to determine if you can wait.
3. My personal preference is to treat and see your virologic response. For example, if by week 4 and week 12 your viral decline is suboptimal, then I would not proceed any further since the chance of cure is so low. I think the investment of 12 weeks of therapy is worth it, particularly if you are tolerating the treatment.
4. Yes there are new drugs coming down the pike, but it will be some years before we can prescribe them. That is another reason why I would recommend a short-term trial of therapy.
Hope this is of help to you in your decision-making.
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