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Neupogen for CD4 counts
Feb 21, 2009

I had an excellent response to interferon treatment (HCV undetectable at 12 weeks) 24 wks to go. I am co-infected w/ HIV and my cd4 count was 205 beginining treatment, but now is 95 after steady decline w/ a few wks of increased cd4 counts. So, I/m worried about further decreases in that count; the percentages have remained good throughout (24%)because HIV morbidity is so closely related to cd4. I know neupogen doesn't increase cd4 counts too much, but my wbc is 1.8 .. won't neupogen help me anyway? or is that a "last resort" treatment to get me through the last wks if I go neutropenic? I'm on the full dose of Pegysys, but 800 ribavirin because of my genotype (2b) hemoglobin was down to 10.1 but is now 12.6, but I feel alot worse (fatigue, exhaustion, head/joint/muscle aches, etc) Is this a normal response? First mo. of treatment was horrible (worse than high-dose chemotherapy I was on for unrelated lymphoma 2 yrs back), then things got better in mos 2-4, now I feel worse than I ever did and can now understand why people quit. Thank you doctor.

Response from Dr. McGovern

Keep the faith!! You are doing extremely well since your HCV RNA was nondetectable by 12 weeks. Your chance of cure is high because you have genotype 2 infection which is relatively easy to treat. Cure of HCV infection would be extremely important for your overall liver health.

Your CD4 percentage is very good at 24% and I would remain focused on that. I have seen coinfected patients develop thrush on interferon so be on top of that if you see any signs of it. Thrush will respond well to fluconazole. However, I can't stress enough that your CD4 percentage is very good and I am reassured by that.

Yes you could eventually need Neupogen if your absolute neutrophil count drops too low. After a shot of Neupogen your white cell count will boost - which will also artificially boost your CD4 count - but you will probably see no change in the CD4 percentage. I think this latter measurement is more reliable.

I know that last thing you probably want to do is to exercise, but I think the patients you regularly do get through the therapy better.

If your doctor checked your HCV RNA level at 4 weeks, ask him or her if your viral load was non-detectable. If so, perhaps you can stop therapy earlier. There is a bit of published data suggesting that this may be possible for patients with a rapid response. If this was not checked, then I would try to stay the course for as long as you can.

Speak to others who have been in treatment themselves to get the support you need. This treament is not easy, but your chance of cure is excellent. Perhaps write on your calendar... 100 days to cure, 99 days to know what I mean...Psych yourself up...

Hope this was helpful.


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