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HIV meds in HIV/HCV person

Mar 18, 2002

what is the best combination for a coinfected hiv/hcv person cd4 count 255, vl 19,000. Had 3 months of combivir and viracept approximately 1.5 years ago, and transaminases increased to approximately 1500. Hiv meds were d/c'd, liver bx showed chronic hep c stage 2. Currently LFT's are completely normal. cd4 cts and viral loads held their own but cd4 has gradually been decreasing and hiv meds will need to be started. What suggestions do you have regarding a regimen?

Response from Dr. Dieterich

If the biopsy was a stage 2 a few years ago, it is undoubtedly worse now. The first thing to do would be to treat the HCV with peg and ribavirin. The normal LFTS do not mean anything and the biopsy is significant. The peg has about a half log HIV effect too and may help you out there as well. After 2-3 months on peg and RBV then I would start HIV meds. Nelflinavir is usually an easy one on the liver. You could use Trizivir and either nevirapine or efavirenz. If you use D4T or DDI, you should check lactates frequently. Ritonavir is the most likely to cause toxicity and saquinavir and amprenavir along with nelflinaivir are the least likely. Good luck! DTD

Follow up: cd4 decline
STI therapy

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