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Hepatitis and HIV CoinfectionHepatitis and HIV Coinfection
           
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Resistant Hepatitis C
May 9, 2010

Hello Dr. McGovern,

In September 2008 I was diagnosed with Hepatitis C genotype 1 B. Blood test showed the value for Hepatitis C Virus RRNA, QL, NUCLEIC ACID PROBE of 3,950,000 IU/ml and RRNA, QL, NUCLEIC ACID PROBE 6.60 LOG IU/ml.

Rx plan consisted of Peg Intron 150 mcg week SC. Ribavirin 2 capsules, 200 Mg BID. Initially I showed a significant drop in viral load until I hit a plateau in June 2009. At that time my doctor increased Ribavirin to 5 capsules totaling 1,000 mg a day also continuing the same dose of the Peg Intron. In July I saw a new doctor who increased the Ribavirin to 3 capsules twice a day or 1200 mg and kept the same dose of Peg Intron.

I reached a non-detectable virus level from November 2009 through February 2010 and continued these dosages until May 5. However, my May 2010 tests showed a viral load of 21,254 with a log of 4.33.

Consequently, my doctor has stopped treatment. Can you provide any information for new or experimental treatments available?

Thanks,

Jack

Response from Dr. McGovern

Because of the dosing changes, I would suspect that either you may have gained weight during therapy or the initial dose was not high enough for genotype 1. We usually dose ribavirin about 13 mg/kg for that infection.

I think you will be an excellent candidate for the new drugs that are coming down the pike because you did respond transiently to PEG/RBV. We expect a new protease inhibitor probably by 2011 so stay tuned! The new drug is telaprevir and will hopefully be reviewed by regulatory agencies in the coming months. In combination with PEG/RBV, telaprevir leads to a sustained virologic response in the majority of patients, particularly those who did have some response in the past to PEG/RBV.



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