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CD4 drops on HCV treatment
Dec 7, 2008

Dear Dr. McGovern:

First of all, thank you for all your wonderful work! We all love you.

My husband is HIV/HCV co-infected. About 8 weeks ago, he started HCV treatment of Geno 1, high viral load. Despite the odds of success, he was undetectable at the end of 4 weeks.

Two questions: 1. What are his chances of SVR at this point? Would you recommend 48 weeks or 72 week of treatment?

2. His CD4 dropped from 340 to 200 after only 8 weeks of treatment but % actually increased to 39%. How worried should we be? Is there a risk or OI if it drops any lower?

He's doing great overall: minimal liver damage, good health, no infections.

I'm so worried.

Thank you so much.

Response from Dr. McGovern

Wow, am I excited to read this! A non-detectable viral load with high viral load genotype 1 infection at four weeks. I would only treat for 48 weeks and would NOT expose him to 72 weeks.

I would put his chances of a sustained virologic response at greater than 80 percent based on some recent data.

I would emphasize that every dose of ribavirin and pegylated interferon are really important for success. Take the ribavirin with food for maximal absorption.

The CD4 drop is to be expected. I tell all my patients about this before they start therapy. I also tell them not to worry because the CD4 percentage also increases.

The main infection I am concerned about in this range is thrush/candidal esophagitis. If thrush develops, I treat promptly with antifungal treatment and then give once weekly prophylaxis. Pegylated interferon can decrease T cell responses to Candida, which is the pathogen that causes thrush. This is easy to treat.

He should do extremely well!



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