December #54 : When to Treat Hep C?

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Table of Contents

The AIDS Decade: The 99 Greatest Moments of the '90s

Inside Agitator

Happy Holidays?

It's 10 O'Clock. Do You Know Where Your Meds Are?

Publisher's Letter

Mailbox-December 1999

Your Money or Your Life

Mass Appeal

STARHS Search

Parallel Universe

Arts

Syph 'N' Spin

Hot Copy

Attention, Shoppers

Where Did HIV Come From?

The Spirit of St. Louis

Splendor in the Pines

Keeping the Faith

Milestones

Tenement Dreams

10,000 Hemophiliacs

Just Eat It

Food Fight

The Hit List

Compound Interest

When to Treat Hep C?

Hep Help Hurray!

The Scoop on Poop

Could You Have HAD?

Shelf Life

Vintage Gallo

Days of Wine and Doses

Less Is More

Cutting Corners

A Day Without

Catching Up With



Most Popular Lessons

The HIV Life Cycle

Shingles

Herpes Simplex Virus

Syphilis & Neurosyphilis

Treatments for Opportunistic Infections (OIs)

What is AIDS & HIV?

Hepatitis & HIV


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December 1999

When to Treat Hep C?

Q: I have both HIV and hepatitis C virus (HCV)--so far without HCW-related symptoms. But on my most recent test, my liver enzymes were elevated. Should I start the alpha interferon/ribavirin combination (such as Rebetron) approved for HCV treatment?
--P.J., San Bernardino, CA

Douglas Dieterich, MD
Investigator, American Foundation
for AIDS Research study of ribavirin/alpha interferon vs. alpha
interferon alone for people with
HIV and HCV, New York City

Patients found to have both viruses should be treated the same as those with HCV alone—early intervention with ribavirin/interferon—in tandem with the usual antiretroviral therapy. The old studies that found interferon to be immunosuppressive for people with HIV were done along with high doses of AZT; most of today’s doses are much lower. The real worry is the ribavirin, which can lower the effectiveness of AZT and d4T. But in general, as soon as you know you have hepatitis C, you should begin treatment, since your immune system isn’t getting any younger. We haven’t seen any problems so far in our study.

Joseph Sonnabend, MD
Longtime AIDS specialist in New York City and leading expert on interferon

The answers on how to treat coinfection are not yet clear. The advice I often hear—get treated, willy-nilly—is wrong: We have long known that when a person’s AIDS gets worse, interferon levels go up. Some HIV/HCV coinfected people on interferon have a crash in CD4 cells, and although the cells may come back later, we don’t know yet who is appropriate to treat in this manner and thus take the risk. You first have to assess a person’s specific situation with both diseases. People with low CD4 counts should be very cautious and may want to wait, unless HCV disease is advancing. For those with high CD4 counts, there is less risk from ribavirin/ interferon and it may be worth trying. Either way, anyone on interferon should carefully monitor their CD4 count.

This column contains general medical information only. Consult your physician before making treatment decisions.
Interviews by Maia Szalavitz





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