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Co-Infection with HCV and peripheral neuropathy problems - What to treat first
May 12, 2009

I have recently confirmed after after 2 neg test that I am pos for HIV/HCV in month 4. During this period I developed Trush that will not go away (Ny and chroz) and recently developed NP of my feet. My CD4 is very low at 320 for a newbie with very high VL and my doctor said that it will recover after the acute phase.

Based on this should I start HCV treatment during my SVR window or hold off to delay the onset of NP by starting HIV treatment first. My doctor wants to reduce my NP symptoms before they stay chronic that could develop quick which nerves damage can't be reversed based on the quick symptoms in only 4 months.

The real question after reading so my excellent post, is my NP due to HIV or HCV. How do I find out to ensue I treat the root issue. I am 37yrs old and the other option is to do both and is this a good idea?

Please help as I don't want to be a cripple and taking meds for HIV with NP. Wha't the point.

Response from Dr. McGovern

If I understand you correctly, your doctor thinks that you recently acquired both HIV and HCV infections. If your HCV infection is acute, then your best chance at cure is with rapid initiation of therapy. However, with that said, there is no data to say if this would be a good idea with your relatively new HIV infection as well. One point in favor of treatment with interferon is that it will also cause your HIV viremia to decline. One point against it is that it can sometimes be associated with candida esophagitis (10 cases in the APRICOT treatment trial).

A lot will depend on what your HIV physician is thinking of doing. If a clinical trial for the treatment of acute HIV is near you, it may be a good idea to enroll. If not, you will need to discuss with your physician if he or she is considering treatment at present. I would favor treatment for your HIV now due to your thrush, which I am concerned about. However, there is no good answer here since the data are mixed about what to do. No treatment is reasonable as well.

After initiation of ART I would favor HCV treatment after about 6 weeks of HIV therapy to see if you are tolerating your HIV medications.

If you have genotype 2 or 3 infection, I would be happy to wait since you will probably still respond to HCV treatment well in the years to come since these types of viral types are relatively easy to treat.

If you have HCV genotype 1 infection I would favor early treatment to give you the best chance at cure.



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