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Interferon and Rebetrol treatment necessary?
Jul 4, 2001

Hi,

I have been positive for nearly five years and have been treated with Viracept and Combivir for nearly 4. Recently my doctor diagnosed me with chronic Hepatitis C and recommended that I have a liver biopsy (which, by the way, was absolutely painless). The biopsy showed following results: 1) Inflamation was 2-3 on a scale of 4. 2) The test indicated some necrosis and fibrosis. Because of this my doctor has STRONGLY suggested that this is the right time for treatment with Interferon and Rebetrol which should last nearly a year.

My questions are these: Does this therapy sound too aggressive at this point? Is it possible that the meds I have been on have become somewhat toxic & have therefore inflamed my liver? Should I suggest taking a drug break and re-checking the results in 3 months?

Also, I understand the treatment is successful in about 60 of individuals with HIV. Is this what you are seeing?

One last question.My grandmother was diabetic and I worry about the possibility of developing diabetes because of the protease inhibitors. What signs should I watch for and can I use this coctail therapy as long as the bloodwork keeps coming back okay?

Thanks very much for your time.

Response from Dr. Rodriguez-Torres

We think that the HAART drugs that we use in HIV,probably agravate the liver disease in coinfection.This may happen not only by direct hepatotoxicity, but also with the steatosis(fat) deposition in the liver.Nonetheless, the main problem is HCV,and you should consider therapy. We want HIV patients to be well controlled from the HIV,before HCV therapy is started, so patients should not stop treatment, unless definite toxicity is suspected.The changes you describe in the liver the biopsy, are secondary to HCV ,and will not improve with HIV treatment discontinuation. At this point in time ,I would consider that your best alternative is not Rebetron but Peg.interferon and Ribavirin.The first global study in coinfection,with Pegasys and RBV is in the last stages of enrollment.The preliminary data will be available next year,but I think this will be therapy of choice in coinfection. You should discuss with your doctor if you can wait for this therapy or consider other Peg.You need to discuss also,the differences in side effects between different treatments before you make your selection.



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