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Newly diagnosed with hep c,also have hiv..........
Nov 23, 2004

I recently found out I have hep c and may have been co-infected all along. I have been hiv for about 16 years. My HCV viral load is 7 million. My doctor says the hep c hasn't been a problem for me and doesn't recommend treatment at this time. My question is have I cut my chances of survival in half? How realistic is it to believe I can live a long life with both viruses?

Response from Dr. Pierone

Studies have shown that many people with HIV infection are co-infected with Hepatitis C and testing for this viral infection should be part of routine care (even for those with normal liver function tests). If the antibody test is positive, a Hepatitis C genotype and viral level should be measured.

This virus is different from HIV in that the viral load does not correlate with stage of disease. One person may have a Hep C viral level of 30 million and have no fibrosis on liver biopsy and someone else may have a viral level of 200,000 and have cirrhosis. Currently, the only way to accurately gauge the grade (inflammation) and stage (fibrosis) of Hep C is to have a liver biopsy. This may changing though, a blood test called Fibrosure is a promising approach that may allow non-invasive determination of liver status. Liver experts are not yet convinced about Fibrosure though, and studies are ongoing.

Regardless, some assessment of liver status should be undertaken in someone with Hepatitis C in order to determine prognosis and potential need for therapy. The prognosis for someone with minimal liver fibrosis and inflammation is excellent. On the other hand, stage 4 (cirrhosis) changes on a liver biopsy would be cause for concern and aggressive management.

Ask you doctor about liver assessment and this should help answer your question about long-term prognosis. Some new agents in the pipeline promise to revolutionize the treatment of Hep C in the coming few years, so even for people with significant disease there is reason for optimism. Good luck.

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