Hepatitis C Management

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Question:

The patient is a 39-year-old, 222 lb male coinfected with HIV who started peginterferon alfa-2a with ribavirin last week. He experienced bloody diarrhea twice. His last platelet count before therapy was 166. Could this be related to therapy?

In a patient coinfected with HIV and HCV, the cause of bloody diarrhea (mostly infectious diarrhea) need to be determined. The interferon will both stimulate components of the immune system and suppress others. Patients are considered more susceptible to other infections while they are on HCV treatment. Patients with HIV-HCV coinfection suffer a greater than normal incidence of neutropenia, which increases the risk of infection. However, interferon is known to stimulate other immune system responses, so patients who are predisposed to autoimmune conditions (such as Crohn’s disease and ulcerative colitis) may see onset of a new autoimmune medical problem. In any case, bloody diarrhea is not expected during treatment and should be thoroughly investigated.

For more information, see the section on hepatitis C in patients with HIV in the Hepatitis C Management monograph.

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