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Hepatitis and HIV CoinfectionHepatitis and HIV Coinfection
          
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recent HIV/HCV
Jan 19, 2013

I am 33 year old male, generally in good health. HIV+ for seven years, TCells 600, Viral Load undetectable. I was recently diagnosed with HCV, genotype 1, viral load 50k. Last test in August was negative. So it is still in the "acute" phase. No symptoms related to HCV. My HIV doctor tells me I should wait 12-24 months for an interferon-free therapy to go on treatment, that HCV won't have time to damage my liver in two years. I also read on your site that the HCV infection takes decades before it causes significant damages. What is your opinion? Should I go on interferon therapy? Should I wait?

Response from Dr. Taylor

In general, I agree with your doctor. Typically it takes time for hepatitis C to damage the liver. Factors that accelerate scarring in the liver include HIV infection. Having a non-detectable HIV viral load helps slow down the scarring process so it is good to hear that your HIV viral load is undetectable. Alcohol use may also accelerate liver damage so avoid alcohol of all types. Daily marijuana use may also move the scarring process along, so avoid this. Having other types of liver disease such as steatosis (fatty liver disease), may also move the scarring along. I evaluate for other forms of liver disease (for example, hepatitis B, hemochromatosis, Wilson's disease) in all of my patients with hepatitis C.

If you wait for interferon-free treatment, I would check with your doctor every 6 months regarding your physical exam, platelets, albumin, PT, bilirubin, APRI, maybe abdominal ultrasound, fibrotest or fibroscan even better if you have access, and how you are feeling, as there is evidence from Dr. Fierer in New York that some men catching hepatitis C after HIV may experience a more rapid disease course.

Clin Infect Dis. 2013 Jan 16. [Epub ahead of print] Rapid Progression to Decompensated Cirrhosis, Liver Transplant, and Death in HIV-Infected Men After Primary Hepatitis C Virus Infection. Fierer DS, Dieterich DT, Fiel MI, Branch AD, Marks KM, Fusco DN, Hsu R, Smith DM, Fierer J. PMID:23264364

Some people are interested in achieving cure of hepatitis C sooner, before the interferon-free treatments are widely available, and thus try to access clinical trials, which is another option to consider if you have access.



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