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Recent HPC infection, when to start treatment?
Sep 24, 2011

Dear Doctor McGovern

Ive been feeling pretty grim over the past few days so came to this site to see if I can work out a way forward. I have to say there is some great info on here so thank you for all your advice so far but here is my question.

I was exposed to HCV mid July 2011 (I think), by the end of July I felt unusually fatigued, knocked out with tiredness for a week or so. There is a slight chance that I could have been exposed a few months sooner, I cant be sure. Beginning of August I went to my doctor for tests. I did not have antibodies to HCV but had a viral load test which showed a high viral load. My energy levels improved somewhat but I still have a high viral load and now feel nauseous and have dark urine. Over the past week I have had weird numbness in my right toes, I didnt even connect this hep c but think it might be connected. My doctor suggested I start treatment but I want to wait for as long as possible before doing this as I have a pressurised job that involves lots of travel. I am not sure how long I should wait for before starting treatments. I am really hoping I will clear HCV without treatment. I have been HIV positive for 15 years, am on Atripla, my cd4 is 500. I was doing really well until I got hep C and now feel worried and confused about what to do, or expect. Any advice would be appreciated.

Thanks, Rob

Response from Dr. McGovern

Dear Rob:

You have described a clear case of acute hepatitis C infection. I am positive it is "acute" or "new" because your antibody was negative yet your astute doctor found virus in your blood. Viremia (virus in the blood) precedes the antibody conversion. I have seen many patients with acute HCV infection.

I agree with your doctor that rapid treatment is in your best interest in terms of a great chance of clearance. New infection is generally easier to clear than chronic infection.

However, if you feel that the time is not right for you, I think that is okay now that we are getting much better agents for the treatment of HCV genotype 1 infection, such as the protease inhibitors (telaprevir and boceprevir). If you have an easy to treat genotype like genotype 2 or 3, the rush to treat is even lower because the treatment response rates with pegylated interferon and ribavirin are excellent.

If you had asked me this question about a year ago, I would be urging you to get treated ASAP. Now with the new field of HCV medications growing, I feel a bit less concerned.

Keep in mind though that patients with HIV are at risk for more rapid progression of liver disease though so continue to take your HIV medications with excellent adherence. Keeping HIV at bay is also important for liver health. Make your liver your first priority as soon as you can.

And work closely with your doctor who is right on target! You are in good hands. Some doctors might have missed this diagnosis.

So I hope this is helpful...I think you have options and you just need to think it through. Also keep in mind that not all patients suffer severe side effects on pegylated interferon and ribavirin. You could also try the treatment for a month and see how you do....It is important to know that you have been infected and you need to follow-up shortly to see if you clear on your own. The chance of that is lower in HIV infected patients however so keep on top of this.

Make sure you have been immunized against hepatitis B and A if you have never been exposed.



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