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Coinfection Treatment- Does old Mono treatment work better for acute patients
May 12, 2009

There is a lot of conflicting information for the best tratment for a coinfection. As I prepare to discuss this my Hep doctor, could you add your thoughts to what I should do.

First, a May 31,2007 issue of Aids, "Is Peg inter mon the best firt line treatment for acute HCV in in HIV + indivduals" suggusted that patients should start with Intron A mono first with no-combo for acute HCV. The report stated that a SVR of 59%-71%. They also stated that following this recommendations, retreatment can be more effective with standard treatment that combins Peg & ribavirin. The authors contend this is no difference in SRV between the two and provides additional options for next treatmen to use ribaivrin. They go on to say at SVR is lower if ribaivrin is reused in any follow up treatment.

The next study is with current treatment options.

The finding is important because as many as 300,000 of the estimated 1 million Americans infected with HIV also have HCV, and as people live longer with HIV, HCV is becoming a serious health problem.

The multinational study compared treatment with the drugs peginterferon alfa-2a (Pegasys) and ribavirin (Copegus) to treatment with the older treatment of interferon (Roferon-A) and ribavirin. Results showed the Pegasys-ribavirin combo was 40-percent effective in reducing HCV RNA to undetectable levels, compared to 12 percent for the older treatment. The drugs were even more effective in patients with the HCV genotypes 2 and 3, reaching 62-percent effectiveness. Patients with these genotypes who were on interferon-ribavirin saw a 36-percent effectiveness rate.The Pegasys-ribavirin combination in patients with genotype 1, typically the most difficult to treat HCV genotype, was 29-percent effective. This compares to an effectiveness of 7 percent among those taking interferon-ribavirin.

Researchers say the results of this study are groundbreaking news for the hundreds of thousands of Americans who are living with both hepatitis C and HIV.

Based on these two studys, would you recommend starting with mono treatment or move into the standard treatment. I want to increase my odds and is going the mono route the right answer or is there holes in the mono route.

What should I be asking my Hep C/HIV doctors to make this time critical decision. Sometimes there is too much informaiton. Please help.

Best regards,

Response from Dr. McGovern

You are certainly doing your homework!

The treatment of acute HCV and chronic HCV are different in terms of approach and duration.

Acute HCV: There are ongoing trials to see what the optimum treatment course should be for HIV infected patients with acute HCV. Some argue for monotherapy and some for combination therapy. I think the data argue more strongly for combination therapy at present but we will know more over the next year or so. A recent paper in Clinical Infectious Diseases just came out that showed very nice response rates of 80% with combination therapy.

Chronic HCV: Combination therapy is always indicated for chronic infection no matter what the genotype or the baseline viral load. The study you are quoting appears to be APRICOT (I recognize some of the numbers you present) This was the largest clinical trial which clearly demonstrated the efficacy of pegylated interferon alfa 2a (Pegasys) plus ribavirin versus standard interferon.

In general, cure rates are also higher when you treat acute HCV than when you treat chronic HCV.



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