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HIV/HBV/HCV triple infection
Mar 25, 2010

I have all 3 viruses.HBV DNA is undetectable with Tenofovir/FTC and together with Nevirapine,my HIV is undetectable also.I was diagnosed with both of these in 1990.

I am monitored every 4 months at the hospital and in March 2009 my liver function tests tests came back with raised ALT/AST levels.My doctor suspected HCV infection.Blood tests were done and was confirmed that I had been infected with HCV.I am pretty sure that I caught it at the end of 2008/early 2009 and started Peg-Interferon Alpha 2b and 1000mg Ribavirin in June 2009.Pre-treatment,I had 3 or 4 VL tests done.Ist was around 250,000.2nd was around 150,000.3rd was around 100,000 and the 4th was done on the day I started HCV treatment,23rd June.That came back as 6,276.

On 17th July,more blood was taken and it came back as <15 detected.Next test was on 9th Sept and it came back as <15 not detected (and has stayed like that on the following tests).Could you explain the difference in <15 detected and <15 not detected?

Also,the main question I want to ask is this.With those blood test results in mind,would you treat me for 48 weeks or would you push me go for 60 or 72 weeks? My doctor is going to push me to go for more weeks but I am not sure if I can manage anymore than 48 weeks as I am really struggling with side effects like anemia,depression,skin problems etc and have done for the last 40 weeks! (All typical side effects,I know).

Do you think that adding extra weeks of therapy is anymore of a guarantee of treatment success? (Even though I do know that there are no guarantees with HCV treatment!)

Getting a 2nd professional opinion would be a great help and I would very thankful if you could share your opinion with me.Thanks.

David.

Response from Dr. McGovern

Since you had newly elevated liver tests, recent acquisition and a falling HCV RNA down to 6,276 just before treatment, I would be inclined to only treat for 24 weeks. This level is extremely low and your immune system was obviously working to contain the HCV even before therapy began.

You will do great! But be certain to not put yourself at risk again. HCV is very transmissible through injection drug use by sharing needles, cotton or cookers. HCV is infrequently transmitted through sex; however, there have been many reports of acute HCV among MSM for several years now associated with traumatic anal sex or in the context of other ulcerative diseases like syphilis.



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