May 25, 2012
I am co-infected and taking Isentress & Truvada for my HIV. I have only been on meds for a little over two years but have known about my co-infection for over 16 years. My very first set of labs taken in 1995 placed my cd4s @ 330 and VL @ 6000. My HVC was determined to be Geno A and my VL was over 2,000,000. I had a biopsy and was rated between f1-f2. At the time the my IDS did not think that treating the HVC would have a good result because of my lower CD4 and the low cure rate. Because I felt good and wasn't having any problems I put off treatment of my until a few years ago because the data started showing that treating the HIV slowed the advancement of the HCV in some people. I have had yearly ultrasounds and indeed I do have an enlarged spleen and low platelets but no other symptoms or problems. I had a another biopsy 6 weeks ago and was told that I now have Compensated Cirrhosis. The recent liver panel stated that my bilirubin is 1.3, AST 72, Alt 144 and my HCV VL is 350,000 . I also just had an EGD and there was no varices present which I take to be a good thing. My cd4s are now at 450 and I am UD. My question is since it took such a long time for my liver to advance to cirrhosis should I try and treat the HCV since there are new and better therapies even though I have liver damage or is it too late to try? Thanks, Billy
Response from Dr. McGovern
Thank you for this careful discussion of your history. That is very helpful to me so I can give you the best advice I know.
You should definitely consider triple therapy for genotype 1a infection (I think that is what you meant to type in your note).
Your liver disease has progressed to cirrhosis. However, since you are still "compensated" (eg, you don't have fluid in your belly such as ascites, you are not confused, you don't have bleeding problems) you are still a candidate for treatment.
I would recommend either PEG plus Ribavirin plus either telaprevir or boceprevir...This HCV protease inhibitors are making a big difference in cure rates. Although the data are among small numbers of patients, the cure rates are about 30 percent higher with triple therapy than dual therapy. Furthermore, your HIV medications won't interact with these medications. However, you will need very careful follow-up because we don't know a lot about the use of these medications in patients with cirrhosis.
I am happy you got an endoscopy. You should also have an ultrasound of your liver every six months.
Other things you can do...Avoid alcohol, get immunized if you haven't already against hepatitis A and B, keep trim...and keep up the good work with your HIV medications. Always ask your doctor about any over the counter drug or herbal meds so you don't harm your liver.
Best of luck with your therapy!!
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