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Pedi/Teen - HIV/HCV Treatment
Apr 27, 2009

My daughter is only 12 years old and was infected with HIV/HCV from my divorced drug abused father of mine during a weekend sleep over. Long and sad story but I need to move on and help her through this. All her COD, % and load are excellent and even her Liver test continue to be normal. The doctor would like to hold off any treatment and meds until he seems them changing. He has discussed starting HCV treatment sooner rather then later but I am concerned of the side effects and success rate starting treatment after the acute phase. Here are my questions that I would like to reslove.

1. All my reading indicates the HIV/HCV infected indivduals (Gno type 1, white) have low SRV rates but I have not seen any information on pediatric patients. Do they have the same SVR success and she age appropriate to start? 2. At her age and with both infections, doctors and web sites indicate that HCV will accelerate and could cause fibrosis/cancer in litter as 10 years. Is this really possible or is this worst case. What type of life expectancy can I expect so that I can plan her future. There is so much on the web that is very confusing. Some say no difference if they are on HART compared to mono HCV patients. What would be your realistic life expectancy for her? 3. Is there any benefit starting HIV treatment during (less 1 year) chronic phase or once past acute it does not matter. This would be helpful to coordinate this prior to starting her HIV treatment so that we can continue to monitor her liver function and fibrosis etc. I don't want to start to soon or too late. 3. Clinical Trails. My last million dollar questions is should we hold out for new treatments options. I have been reading a number of new, less toxic and easier to admin medications including Vertex for HCV that will greatly improve treatment options and life expectancy. Weighing all the rist, should we hold off as long as possible or switch over when approved. I an worried about switching if the meds are working and resistance.

Thanks for keeping us informed as we make critical decision about our future

Response from Dr. McGovern

I suspect her prognosis will be very good because there are so many excellent HIV medications; furthermore as you suggest - new medications for HCV are in the works - many new agents are in development such as the protease inhibitors and the polymerase inhibitors. Hopefully in about five years there will be many more choices for HCV treatment.

The timing of therapy is difficult to say since I don't know how long she has been infected. If less than six months, starting now would be a good option due to high cure rates in acute/early HCV.

Young children generally do better than adults with interferon and ribavirin.

If she has had her infection for several years,a biopsy or some noninvasive markers may help stage her disease if she does not desire treatment. This will help determine if waiting is okay. If she is inclined to be treated, but does not want a biopsy, it is reasonable to try treatment and simply measure the viral load response to see if she is responding optimally.



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