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Is Interferon therapy helping my HIV??
Mar 27, 2000

Hello Dr....I tested + for HIV and HepC in 4/99. I've never been put on HIV medications, but started the Rebetron treatment for HepC Oct.10,99 (due to my liver biopsy). I had to stop the Rebetron treatment mid-dec. 99 because my cd4 count dropped to 300 (was in the 500's) and because i did not become undetectable with the HepC. I also had severe side effects to the Rebetron (guess it was the Ribavirin part). I've continued with the interferon, however. I'm somewhat perplexed with my vl and cd4 counts because they are very good...and of course i am thankful. Can you tell what may be going on here? Is the interferon actually helping my good counts as far as the HIV goes? Here's my vl and cd4 counts since when i first tested + for both:

5/7/99.......vl 19,500.........cd4 558

8/13/99......vl 8,400.........cd4 563

11/12/99.....vl 1,200.........cd4 307

3/3/00.......vl <400.........cd4 589

As you can see, the ribavirin caused my cd4 counts to drop, but they're back up higher than ever now....and I'm <400 vl. My dr wants to continue me on the interferon for at least another year. Can i expect my HIV counts to stay good? I'm somewhat concerned to stay on interferon for a year and a half because of possible long-term problems with interferon use. My HepC vl was initially 850,000...went down to 2,500 during rebetron treatment....now back up to 650,000. So it doesn't seem the interferon is helping much with my HepC vl, however it may be helping my liver rebuild itself. Would you recommend staying on the interferon? thanks dr....robert

Response from Dr. Cohen

Dear Robert.

It is hard to comment on your results specifically. We do know that interferon adds a moderate (0.5 log) benefit in reducing viral load (AIDS Res and Human Retrovirus 2000;16:183). We also know that ribavirin can suppress the bone marrow, which might lead to a reduction in your CD4 count. We also know that there are some data saying that interferon may prevent severe liver damage in Hep C even when it is not succeeding in controlling the Hep C viral load. These all sound like reasons to stick with it. However, as you know, interferon is expensive, hard to take and the side effects can be very difficult. We don't know if long term use of interferon when it is not suppressing the virus will lead to resistance (some information says yes).

Sooo... tough call. You have to balance how you feel on the interferon, how bad your liver biopsy is, with the possible benefits.

Hope a little more info helps you make the call



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