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HCV genotype 2 relapser. Now what?
Jan 15, 2010

Hello Dr. M. I was superinfected w/ HIV/HCV/HBV. Got the HIV ud quickly on Atripla 2 yrs ago. Finished HCV Tx w/ INTF/RBVN full dose of each (1000 mg RBVN) never missed. Had geno 2b of HCV. Went ud w/ HCV about 6 wks after initiation of Tx, and never relapsed while on the drugs, which I took religiously. 4 mos. after ending HCV Tx, HCV is back @ 24,900 vl (When I started treatment, it was 9million+) Hepatologist said: well, you should have cleared, but at least you got some histological benefit (yeah, and I went from CD4 of 200 to nadir of 55 on terrible treatment too). So, I asked him about the new drugs for HCV (teleprevir (sp?), etc. He said those drugs are ONLY going to be for HCV geno 1a and 1b, not geno2s like me. I was crushed! So now I'm getting an MRI, so he can tell me "how much time" I can expect to live. Thanks for your help.

Response from Dr. McGovern

I would consider re-treatment sometime in the future.

Your CD4 cells should continue to rise over time and HIV suppression itself has been found to be associated with improved liver health.

Your first response to HCV therapy is still encouraging to me because you became nondetectable. But if you only first cleared at 6 weeks of treatment, that is not as rapid I would like to see for a genotype 2 infection.

If you are found to have advanced liver disease, then you may only need a longer course of therapy - eg, 48 weeks...

Your CD4 decline is to be expected due to declining white blood cells counts on interferon. But if you check the CD4 percentages I would bet they stayed the same.

Take a break from therapy for now but I would consider starting again in the future.



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