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Is HIV and HCV coinfection finally going to kill me?
Feb 10, 2010

I been HIV+for over 20 years but my MD have tell me that I been expose to HCV-1 as well .And I need to treat it now due to the fact that the lab test is showing high concentration of the HCV.HIV is undetectable but my T4 cells are 200 and have been like that under HART for years. This treatment for HCV is very toxic and have only a 50% chance to be eradicated from the liver. What is your opinion in this predicament I found my self? Thank You for your time and compassion.

Response from Dr. McGovern

I feel strongly that you should give the treatment a try.

1. HIV/HCV coinfected patients are at risk for accelerated scarring of their liver.

2. Treatment can cure HCV which can lead to improvement of liver disease.

3. Evaluation of the scarring of your liver may help you decide on whether you want to pursue treatment. However, I favor a three month trial to see if your viral load declines rapidly which would favor eradication. A fast response would be incredibly encouraging and I find that the CD4 count doesn't necessarily predict who will respond.

4. If you do go on therapy, I would follow your CD4 percentage, not the absolute count which will probably fall. You will need to assess with your doctor whether you should go on any prophylaxis while on therapy.

5. Not all patients have severe side effects. That is individual. You won't know until you try.

6. Be certain you are not on DDI which should not be combined with ribavirin.

7. Your chance of cure will also depend on your genotype. Again though the most powerful predictor of response is your viral load decline on treatment at 4 and 12 weeks.



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