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New treatments and co-infection
Sep 18, 2011

My partner is co-infected with HIV and Hep C. Our PCP has suggested that the new Hep C treatments are not approved for co-infected patients (He has previously failed a trial of Interferon and Ribavirin). Is it then true that for the time being the new treatments are not recommended?

Response from Dr. McGovern

Your PCP is right.

There are only preliminary data on the use of telaprevir with pegylated interferon and ribavirin in HIV infected patients who are treatment naive. The final results of this trial will probably be available in 2012.

There are no data yet on how to approach the patient who "failed" interferon and ribavirin. I put "failed" in quotes because there are many ways in which a person may fail treatment:

a) Some people suppress virus completely - but then the virus comes back. That is a relapser. b) Some people have a partial response -but never completely suppress. That is a partial responder. c) Some people hardly respond at all. That is a null responder.

If your partner has a lot of liver disease and time is of the essence, you may want to talk to your doctor about what role telaprevir might play if he was a relapser or a partial responder. In this case, he may do great on triple therapy....If he was a null responder, your doctor may want to wait for more information. Again, the urgency of these decisions will be driven by the patient's underlying liver disease - eg, does the patient have cirrhosis?

Also, the use of telaprevir was only studied in patients taking two different HIV cocktails...So this needs to be discussed as well.

I hope this is helpful. I am anxious to know the results of this trial in HIV/HCV treatment naive patients. The preliminary data look great and are very promising!!

Keep your questions on the treatment of HIV/HCV coinfected patients coming!!!

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