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hep c and hiv
Jan 21, 2012

im hiv positive but not on meds,viralo load is low and cd4,s are above 500.was diagnosed with hep c,it seems like i will start meds for c,but my doc mentioned briefly that i should start hiv meds as well..am i correct not to want to start hiv meds since im doing well,and i dont really need them? i feel that treating hep c first is the way to go,and when the time comes to start hiv meds.please let me know what you think.

Response from Dr. McGovern

You ask a good question. If you don't want to start HIV meds right now, you should simply speak to your doctor since the guidelines are "optional" for treatment in patients with CD4 cells greater than 500.

If you have genotype 2 or 3 infection, for example, you will only need pegylated interferon and ribavirin. If you have genotype 1 infection, you may need PEG, RBV/ and telaprevir or PEG/RBV/boceprevir. This combination was approved in HIV-negative patients with HCV. Trials in coinfected patients are in progress.

If you do start HCV treatment, you may want to see how the telaprevir trial results go since there were some HIV patients who were not on HIV meds and others who were. For example, your decision to go on HIV medications might change if it turns out that the HCV cure rates were much higher in those patients who were on HIV treatment. I want to be clear that I am not expecting any particular result....I am just suggesting that it might be helpful to know the results, which will definitely be out this year.

If you do go on pegylated interferon as part of your therapy, be aware that your CD4 cell counts may drop but your CD4 percentage should stay the same or increase. That is why I always follow CD4 percentages on PEG treatment.

Hope this is helpful.



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