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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