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Hep C co infection with HIV
May 22, 2014

Hi, I have co infection Hep C and HIV. I was diagnosed in 2007 with a very high viral load and my CD4 count was below 200. I was in hospital as I was ill, and they gave me septrin, when they discovered i was G6PD deficient, and was allergic to septrin. My viral load went down to below 40 counts, but was up and down till 2 months ago. They adjusted my meds. I was on Truvada, norvir, rayataz. They found the truvada wasnt working, and i am now on norvir, viread, reyataz and isentress. Since being on this regimen I am back to undetectable. My cd4 count has always been above 1000 for over 3 years. My problem is that I am putting on a lot of weight. I was diagnosed with gaull stones, have G6pd deficiancy, and also diverticulitis disease, had an op to remove part of the sigmoid colon. Would there be any special diet that could be suggested. Is there a set menu that I could follow. I am 49 years old. Male. I gave up alcohol and smoking for over 2 years now. I hope I have given all the details required.

Thanks

Response from Mr. Vergel

Thanks for the detailed email. Most people send very little information.

I hope you are in the United States and can access the new Hep C regimen that does not require interferon. HIV+ people with Hep C tend to have a lot more insulin resistance and potentially more metabolic issues than those only infected with HIV. You are on Norvir, so please watch your triglycerides. High triglycerides can increase the chances of fat gain (triglycerides are basically the juice that "pumps" fat cells). The fact that you had gall stones tells me that you probably have insulin resistance.

Congrats on giving up smoking and drinking! I bet that was hard but so worth it.

With diverticulitis, things are a little confusing. Recently, the notion that a high fiber diet was good for diverticulitis patients came under scrutiny. So did the belief that red meat and fat were bad for diverticulitis symptoms. I wish they had differentiated between soluble and insoluble fiber. I would bet that soluble fiber is beneficial.

Fiber May Not Prevent Diverticular Disease

Knowing this, if I wanted to lose weight while dealing with insulin resistance and diverticulitis, I would eat a diet rich in low fiber protein and carbs (whey protein shakes, eggs, cheese, rice,fish, purple potatoes, yogurt, avocado, fruits like bananas and melon, etc). I would also sweat 3 times a week for 20 min with some sort of exercise (brisk walking, gym cardio equipment,etc) and use weight machines for 40 min three times a week. I would treat my Hep C so that I can not only get cured but also improve insulin sensitivity (we have no data on cured patients and insulin resistance yet, so I am speculating).

I found this great summary of different treatments that have been researched ( Source) :

"Treatment of uncomplicated disease

Large prospective studies have identified a preventive effect of both dietary fibre and physical exercise in the development of diverticular disease.20 Once symptoms have developed, however, evidence of a benefit from fibre is less convincing: of two small randomised controlled trials comparing fibre and placebo, one found no difference in symptoms and the other reported improved symptoms but no change in bowel dysfunction after three months' follow-up. Another randomised controlled trial found that adding rifaximin, a rifamycin antibiotic, to fibre supplementation decreased symptoms after 12 months of treatment; 10% of participants were unable to complete the trial, however, and analysis was not by intention to treat. Although some people may benefit from supplementary fibre, more evidence is needed from studies with longer follow-up before fibre supplementation can be widely recommended.

Mesalazine has been shown to significantly reduce symptomatic recurrence at four years compared with placebo, but abdominal pain was more common with mesalazine. A more recent randomised controlled trial suggests that mesalazine may be superior to rifaximin in overall control of symptoms. A large case-control study found that use of calcium channel blockers, which decrease intracolonic pressure, was associated with a reduction in diverticular perforation. Long term use of opioids (which increase intracolonic pressure) seems to increase the risk of diverticular perforation. Whether these associations are causal remains unclear, so insufficient evidence exists to make recommendations on use of calcium channel blockers or opioid analgesics in patients with diverticular disease."

I hope this helps some.

In health,

Nelson



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