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Ask the Experts about Hepatitis and HIV Coinfection
I found out I had chronic Hep C in 2003. I had no symptoms at all and I think I had it for about 25 years. I had a liver biopsy and was told that it was stage 1 grade 2 and genotype 1 with no cirrhosis. After much reading, I decided to do no treatment at that time since it was minimal fibrosis. I had a biopsy scheduled for 6 years later,,,summer 2009. I found out that I was Hiv positive in March of 2009 from a partner a few months prior to that time. I don't know any CD4 counts. I had blood work done with a follow up doctor appt for August 2009. Should I go ahead and have the second liver biopsy to see if there is additional fibrosis or wait a while and see if the Hiv virus is playing any role in my Hep C life. Coinfection...what a mess for me right now. I am now 60 years old with no other medical problems. I eat well, no smoking, no drinking at all. Weight is 140. Please give me your opoinion as what I should do. Thanks so much. You are the best for taking the time to help us through these difficult times.
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Response from Dr. McGovern
I would pursue the evaluation for your hepatitis C and I would be very inclined to also start HIV medications as well due to your age. The newest guidelines suggest consideration of therapy based on older age. Once you are on HIV medications for about three months, you could consider HCV treatment if your disease has progressed.
Get your HCV RNA checked along with a genotype which will be helpful in determining length of treatment and your chances of success.
Find a doctor who is a good HIV specialist. You also need to consider all your other primary prevention issues as well such as colonoscopy, etc...
Also be certain to be vaccinated for all routine things (eg, pneumococcus) and liver diseases (eg, Hepatitis A and B.)
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