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Co infection Hep C
May 18, 2012

HI I recently discovered that i have HIV and Hep C My Viral Load is over 2 million Hep C and 1100 HIV What would be a great treatment with minimum side effects that focus of Hep C rather than HIV. My doctor seems to believe treating HIV is the first priority

Response from Dr. McGovern

You haven't told me your CD4 T cell count which is an important part of this equation. If you T cell count is low for example (<200) I would definitely want to treat your HIV first. If your T cell count was high (>600 for example) I would be open to treating your HCV first.

However, it is important to be aware that the US treatment guidelines have just changed. The recommendation right now is that all patients with HIV should be treated, regardless of CD4 cell count. The drugs for HIV are effective and better tolerated than earlier drugs...Also, we have learned that untreated HIV can have a negative effect on other systems of the body - like the heart, kidneys, and liver. In fact, there is some information that shows that HIV can infect liver cells and cause problems and that treatment of HIV can slow scarring.

So I favor treating HIV first (in most patients) and then adding HCV therapy when you know the patient is doing well with their HIV medications and there are minimal side effects.

The best treatment will depend on your HCV genotype. If 2 or 3 or 4, PEG interferon plus ribavirin would be the choice. If type 1, then I would suggest triple therapy with the addition of a HCV protease inhibitor. For details on these new drugs, please see my blog. The success rates are much higher with 3 drugs than 2 drugs!!

You should have serial monitoring of your liver function tests and some staging of your liver disease with a biopsy or a non-invasive blood test marker for scarring.

Hope this is helpful.



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