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Whether to Begin HEP C Treatment
May 16, 2001

Hello - I am a supposedly Long Term HIV Survivor - 14 Years, no illnesses related to it, never any antiretroviral or anti-HIV Treatments/Drugs taken. I am also, HEP C postive with an approx. Hep C viral load of 200,000. Never been ill from HEP C either. I am not of a mind to begin anti-HIV medication at any time soon. I suggested to my Physician that we treat the Hep C individually and first, prior to the time I might begin anti-HIV treatment. He says absolutely not. No need to treat the Hep C at this point at all, and many people (I am 49) go all their lives without ever treating Hep C. Do you agree with this position? I am willing to do the new Peg interferon treatment if it might eliminate the HEP C virus completely. Thank you.

Response from Dr. Rodriguez-Torres

You are a lucky patient.I have patients like you in my practice, and what you should do depend of different factors.First,you do not say what is your HIV viral load and CD4 levels.If you are a long term non progressor, with non detectable,or very low viral load,and have high CD4(More than 500)your chances of progression to cirrhosis are less.Second;HCV genotype will be considered ,as if you have a non 1 virus,your chances with treatment will be more.Finally ,in coinfection, the weight of the assestment lies in the liver biopsy.You can have very significant disease,with low HCV viremia,and normal hepatic tests.The literature suggests strongly that patients with higher CD4 do better in treatment,so if you have low levels you should start HIV treatment first. You also should discuss with your doctor, which of the two pegs to use, as there are differences in the safety profile and tolerability.

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