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Liver Biopsy-HIV/Hep C
Oct 6, 2012

I'm having a liver biopsy on next Friday. Was due to start treatment with the Telaprevir/Interferon/Ribavirin last month, but decided to get the biopsy first to ascertain the extent of damage to my liver. I'm HIV+ for 20 years, t-cell count last month 1365, 37%. Acquired Hep C two years ago, in great shape 59y/o. Question - would you recommend making my decision to start treatment on biopsy results, or wait for the interferon-free therapy that will most likely become available next year. I suspect my liver in not in too bad a shape, because I had an ultrasound about a year ago and there was no fatty tissue or enlarged liver. Due to the bad side effects of the triple combo, would waiting be ill advised? Of course, if my biopsy comes back really bad, which I kinda doubt, starting treatment is a given, and I realize that. I just want to make the best decision. I've received advice from two different doctors, one said to go for it and the other said to wait, neither of which were my primary doctor. What should I do??

Response from Dr. Taylor

There are many factors to consider before embarking on hepatitis C therapy with telaprevir/peginterferon/ribavirin for someone infected with both HIV and hepatitis C genotype 1. I recommend that you consider your liver biopsy results before making a decision to start treatment with telaprevir/peginterferon/ribavirin. The benefits are likely to outweigh concerns if your liver biopsy shows moderate to severe scarring. If your liver biopsy shows no scarring or mild scarring, it may be helpful to discuss with your doctors waiting for interferon-free therapy, waiting for additional data on safety and efficacy (the cure rate) in people with both HIV and hepatitis C, and/or waiting for other new hepatitis C medications.

There can be medication interactions between telaprevir and some medications used to treat HIV, so it is important to discuss this with your doctors. Telaprevir interacts with other types of medications, in addition to HIV medications, so this is important to consider with your doctors if you are taking any of these other medications.

Ideally, HIV infection should be well-controlled before starting treatment with telaprevir/peginterferon/ribavirin. It sounds as though this is the case for you, with your very high CD4+ cell count (great news!). Having a non-detectable HIV viral load is also beneficial before starting treatment with telaprevir/peginterferon/ribavirin if you are on HIV medications. If you are not, HIV viral load ideally should be less than 20,000 copies/ml.

It is reassuring that your ultrasound did not show an enlarged liver or fatty tissue. However, sometimes there is liver damage or scarring that is not seen on ultrasound. We use examination of the body, review of many different blood tests and your history to help determine how the liver is doing. Hepatitis C can be sneaky, as it may cause scarring of the liver without anyone feeling any symptoms. Sometimes there is damage or scarring that is not seen on ultrasound, and that is one of the reasons your doctor may have ordered the liver biopsy.

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