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HCV HIV Co-infection therapy duration
Feb 20, 2010

I have been on therapy for HCV genotype 2 for 20 weeks now. I am taking Peg-Intron, 120mcg/0.5mg. & Ribavirin 1000mg. I had a rapid viral response, un-detectable after 11 days, and have been un-detectable since.

Upon starting the therapy I have been experiencing depression, fatigue, weight loss, fits of rage etc. The side effects from this therapy make starting HIV therapy feel like a stroll in the park.

My Doctor advises that the combination of genotype 2 and rapid viral response is a good indicator that I will have SVR and completely clear the virus.

My prognosis is great but....the therapy is putting me through the meat grinder. My Doctor is advising me to stay with the therapy for 1 year due to the HIV. With my genotype and RVR Is there any research which might suggest that I could shorten my therapy?

If I felt I could tough it out for another 7 months I would not be writing you. This therapy is literally tearing me apart! Do you feel I would be a candidate to shorten my therapy from 1 year to 6 months?

Response from Dr. McGovern

There was a 2009 study looking at whether achievement of a rapid virologic response at 4 weeks (RVR) may lead to good treatment outcomes even with only 24 weeks of treatment in HIV/HCV patients by Van Den Ender. The patients who had relatively easy to treat genotype 3 infection did very well if they had a RVR and had a low viral load to start. Similar results were noted for genotype 3 in the PRESCO trial.

Genotype 2 is even more sensitive to interferon than genotype 3 so the same issues apply. I don't know your baseline viral load, but if you are having so many side effects and you cleared after such a short time, you probably have a very good chance of a sustained cure after 24 weeks.

I make these kind of decisions about treatment duration after discussion with my patients since some fly through therapy and others are quite miserable. But you are lucky to have such a good response and to have genotype 2 - the easiest one to treat....Have a discussion with your doctor to tell him or her that you feel you cannot tolerate another six months of therapy....

I think you are going to do well in the long run...Best of luck!



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