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Whats in the pipeline?
Nov 12, 2009

Hi Doctor McGovern,

My partner tested Hep C earlier this year; he is also co-infected with HIV. He doesn't talk much to about the condition and I feel outside looking in.

His HIV is under control on Atripla - undetectable and no side-effects from the meds CD4 500 (ish). His Hep C V/L is around 2m and has reduced significantly over the last 6 months - unfortunately it's the type of Hep C that's difficult to shift with the current meds.

His Fibro scan shows very mild liver inflammation and no scaring. He is attending a co-infected clinic in a very good hospital in London, so treatment costs are a non-issue. Given his current relatively good health and his doctors suggestion to wait for the new treatments to arrive, what can we expect to roll out over the coming months and years? Are you aware of anything in phase II or III thats giving promising data? I guess my hope is that he will remain well until such time there are other, better, options to treat his type of Hep C.

Thank you for all the time and experience you offer to people on this site.


Response from Dr. McGovern

I thoroughly enjoy working on this site in my spare time to help people like you and your partner. My particular expertise is in HIV/HCV coinfection.

I would say the following:

1. Yes, if you have access to fibroscan and the scan suggests mild disease, this is a good sign. We do not have access to fibroscan in most centers in the US. Another way to stage disease is to confirm the fibroscan results with a serum fibrosis marker, as suggested by some hepatologists.

2. I agree with your doctors that with high viral load genotype 1 infection and mild liver disease, it is probably best to wait for better therapies. The liver disease conference in Boston was quite exciting since there are several exciting medications that are coming down the pike and two include telaprevir and boceprevir - both of which are going to be studied in HIV infected patients.

Keep in mind that these protease inhibitors are both going to be combined with pegylated interferon and ribavirin to prevent HCV resistance. The same principles of drug resistance that apply to HIV apply to HCV - multiple drugs at all times!

Best regards for your partner's liver health! Also be certain he is vaccinated against Hepatitis A and B...Also be certain to practice safe sex so you do not acquire any infections sexually.

Is there "flex" in Twinrix accelerated schedule?

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