Hepatitis C Management

Ask The Experts

Question:

Our patient is a 40-year-old Hispanic male co-infected HIV/HCV. His HIV is well-suppressed (<50 copies/mL for over 6 years) and he has a CD4 >800 on combination lamivudine/zidovudine (Combivir) and efavirenz. We treated his HCV 1a (stage 2 grade 2) infection with 48 weeks of peginterferon alfa-2a/ribavirin, which decreased his HCV viral load to <50 copies/mm3 since week 12 of treatment and sustained the level throughout his therapy. Six months after completion of therapy, his HCV viral load is positive at 1 million copies/mm3. What can we offer him next?

There is not a great deal of evidence that re-treating patients without a sustained response to previous therapy with another course of peginterferon/ribavirin can be associated with higher rates of SVR. However, if this patient required dose modification (especially of ribavirin) during the previous antiviral therapy, re-treating with an optimal dosage of peginterferon/ribavirin and supporting him with growth factors may be reasonable. Though extended treatment duration of 72 weeks is not currently included in clinical guidelines, there are some studies (though not in HIV co-infected patients) suggesting this may be beneficial in some cases. As more studies are completed, the value of this option may become clearer.

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