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HIV and Hepatitis B and C Positive
Aug 18, 2001

Dear Dr. Gallant, Someone very dear to me has just been diagnosed HIV and HCV positive. She already knew about the Hepatitis B (which is not chronic or active.)I have been reading on-line for weeks all over the place and it seems to me that you are considered to be in the forefront of this research. You have no idea how much better I would feel if YOU would answer this question for me. I would be forever in your debt! My question is this: My friend is 50 - has probably (almost surely) had C for 20 years, and HIV (almost surely) for 2-3 years. Her HIV count is 800 and liver count 600. Her doctor says these are good numbers. My friend doesn't want any meds. She asked me to look for info for her (she doesn't have a computer, but we are getting her one)and she reads everything I give her. After all that we have read, I know that she must respect your opinion as much as I do. Do you have any valid reasons that my friend should know about why treatment for the HCV before she goes into AIDS is a good idea? If she decides to keep the "wait and see" attitude, then are there specific tests and things she should keep up with to monitor her liver function? Thank you, Dr. Deitrich, for your very valuable time!

Sincerely,

Jo

Response from Dr. Dieterich

Dear Jo, I am not Dr. Gallant, but may be galant just the same! Anyway, your friend should definitely seek treatment for her HCV. She should be evaluated now with ultrasound HCV PCR genotype alfa fetoprotein and liver biopsy. If she has any fibrosis at all on biopsy she should be treated. There is good evidence that HCV goes much more rapidly to cirrhosis in HIV patients and that HIV progresses more rapidly to death in HCV HIV co infected patients. The new peg plus rbv combo is likely to be 40-90% effective in curing the hepatitis C. While she is watching the HIV, she can be cured of the hepatitis C and never have to worry about it again. Finally, the peg IFN would likely lower her HIV levels to undectable, because of it's activity against HIV itself. Wish her luck for me. She should go for it! DTD



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