Hi,
I'm expecting to begin tx in about a month. I'm stage 3/6, genotype 1a, vl around 1.5 million. I'm also HIV positive which is under control with meds (CD4 550-600, vl 101). I know this somewhat reduces my odds for achieving SVR, can anyone tell me whether coinfection is likely to have any effect on the severity of the side effects? I know I'll be taking 180 mg Pegasys, I don't know how much riba I'll be getting yet. From reading some of the posts regarding side effects, I have already received some valuable information from those of you who are going/have gone through this before me. Thanks.
In part:
"A combination regimen of peginterferon and ribavirin (PegIFN/RBV) has been the mainstay of treatment for HCV infection. In HCV genotype 1-infected patients without HIV, addition of an HCV NS3/4A protease inhibitor (PI) boceprevir or telaprevir to PegIFN/RBV significantly improves the rate of sustained virologic response (SVR) [14, 15]. Clinical trials of these HCV PIs in combination with PegIFN/RBV for the treatment of HCV genotype 1 infection in HIV-infected patients are currently under way."
"Following are preliminary recommendations for the use of boceprevir or telaprevir in HIV patients coinfected with HCV genotype 1 based on current ART use. These recommendations may be modified as new drug interaction and clinical trial information become available.
Patients not on ART: Use either boceprevir or telaprevir
Patients receiving RAL + 2-NRTI: Use either boceprevir or telaprevir
Patients receiving ATV/r + 2-NRTI: Use telaprevir at standard dose. Do not use boceprevir.
Patients receiving EFV + 2-NRTI: Use telaprevir at increased dose of 1125 mg every 7–9 hours. Do not use boceprevir.
Patients receiving other ARV regimens:
If HCV disease is minimal (i.e., no or mild portal fibrosis), consider deferring HCV treatment given rapidly evolving HCV drug development.
If good prognostic factors for HCV treatment response are present—IL28B CC genotype or low HCV RNA level (<400,000 International Unit [IU]/mL)—consider use of PegIFN/RBV without HCV NS3/4A PI.
On the basis of ART history and HIV genotype testing results, if possible, consider switching to the ART regimens listed above to permit the use of boceprevir or telaprevir.
For patients with complex ART history or resistance to multiple classes of ART, consultation with experts regarding the optimal strategy to minimize the risk of HIV breakthrough may be needed. In such patients, telaprevir may be the preferred HCV NS3/4A PI because its duration of use (12 weeks) is shorter than that of boceprevir (24 to 44 weeks).
Summary:
In summary, HCV coinfection and use of PegIFN/RBV with or without HCV NS3/4A PIs (telaprevir or boceprevir) to treat HCV may impact the treatment of HIV because of increased pill burden, toxicities, and drug-drug interactions. Because ART may slow the progression of HCV-related liver disease, ART should be considered for most HIV/HCV-coinfected patients, regardless of CD4 count. If treatment with PegIFN/RBV alone or in combination with one of the HCV NS3/4A PIs (telaprevir or boceprevir) is initiated, the ART regimen may need to be modified to reduce the potential for drug-drug interactions and/or drug toxicities that may develop during the period of concurrent HIV and HCV treatment. The science of HCV drug development is evolving rapidly. As new clinical trial data on the management of HIV/HCV-coinfected patients with newer HCV drugs become available, the Panel will modify its recommendations accordingly."
http://www.aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-treatment-guidelines/26/hepatitis-c--hcv--hiv-coinfection