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36 or 48 Wk PegInterferon Regime?
Mar 29, 2009

I was superinfected: HIV/HVB/HCV/HDV/EBV. HIV undetectable; HVB now neg for surf antibody/antigen/core tests/rna vial load, etc. -- all tests now neg. Been on Pegylated interferon/ribavirin for 27 wks. My Heptalogist says it's "up to you" whether I stop therapy at 36 or 48 wks and a "toss up" if it will even help. my genotype was 2b, but my baseline vl was skyhigh at 9.5 million, undetect. on Heptimax test at wk 12, 20 and 24, and I apparently had all the deseases since a massive series of blood transfusions in 1983 consequent to a bad crash. I keep reading about better sustained virological response rates the longer ones stays on the therapy which for me was pretty bad and bearable only by the hope of finally "curing" one of these viruses. I know this is sketchy information but can you give a recommendation? I've followed this site and your many thoughtful responses---and always been right on the nail and I've been always been completely adherent, so thank you very much!

Response from Dr. McGovern

If I understand correctly, you have only acquired hepatitis C infection with genotype 2b and you are currently taking pegylated interferon and ribavirin for 27 weeks. I would be very much influenced by your four week viral load response. If you achieved a non-detectable viral load, probably 24 weeks was already enough. If your physician is treating you longer, perhaps your viral load was detectable at four weeks and he or she is concerned about treating longer.

If you did not have any viral load testing at 4 weeks, I still think 24 weeks would be ample for genotype 2b since in general it is exquisitely sensitive to interferon. Greater than 75-85% of patients with genotype 2 infection responded to treatment in most of the large treatment trials. It is the best genotype to treat.

If there is residual concern about the viral load or that you have very advanced liver disease/scarring, underlying insulin resistance or other factors that can interfere with response, then 36 weeks may be reasonable. However, I certainly wouldn't treat for 48 weeks for a genotype 2b infection.



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