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HIV Management In Depth

HIV/HCV Coinfection Update: From Testing to Treatment

Douglas Dieterich, M.D.Daniel Fierer, M.D.
Douglas Dieterich, M.D.Daniel Fierer, M.D.
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A Discussion With Douglas Dieterich, M.D., and Daniel Fierer, M.D.

June 19, 2013

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Framing the Message

Myles Helfand: I'll close with a general patient management question: What do you tell your newly diagnosed patients about their prognosis? About what they should be expecting to experience over the next few months?

Douglas Dieterich: In terms of the treatment of hepatitis C, what I tell my patients is that it's a really good time to have hepatitis C. There are about 30 new drugs on the way. We're almost certain to be able to cure your disease at some point in the very near future.

In terms of the acute hep C, Daniel, I'll let you take it for those recommendations.

Daniel Fierer: I think the idea is to try to get people treated really early. I can say the same thing to the patient: that the chance of cure, right up front, right now, is extremely high. It's close to 90 percent, I'd say, in our hands here. And the few people who aren't cured here, they will be in the same boat of having really great drugs in a couple of years. So this is a great time to have hep C. If you can have it now and not be super-sick from it already, then we're really going to be able to get people cured.

To reassure people: I think there are probably very few people who can't wait six months [to start HCV treatment]. We know about those people already, probably. They're clinically sick.

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Douglas Dieterich: There may be other reasons that people want to be treated, and not just for the severity of their illness. Social reasons: They're getting married; they want to have a kid; they're leaving the country; they're changing insurance; they're getting Medicare and there are donut hole issues; while they have good insurance, they want to be treated now; etc. There are lots of social reasons to be treated now.

But there are probably not a lot of medical reasons. We're treating almost everybody now, compared to what we were doing two years ago.

Myles Helfand: It's an important point: That as clear as the clinical realities are, there might be social things that you need to get at as a provider in order to be able to really tease out whether the person is a good candidate for starting -- and whether, when they start, they will stick to that treatment until the course is complete.

Daniel Fierer: We believe most everybody now is a good candidate. The days of over-scrutinizing who might be a good candidate are over. As the amount of interferon decreases and the treatment effectiveness goes up, everyone becomes a good candidate.

Myles Helfand: Thank you both.

This transcript has been edited for clarity, grammar and length.

Visit our HIV Management Today home page for more episodes in this series.

Myles Helfand is the editorial director of TheBody.com and TheBodyPRO.com.

Follow Myles on Twitter: @MylesatTheBody.


Copyright © 2013 Remedy Health Media, LLC. All rights reserved.

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Reader Comments:

Comment by: patricia (Concord, nc) Thu., Oct. 10, 2013 at 2:19 pm EDT
Doug you have been hiv pos. since 1981, what is your regime.
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Comment by: Terry (SF) Mon., Aug. 19, 2013 at 12:29 pm EDT
Perhaps the answer is not really more testing, but a return to the normal standards of mom and dad with God's rule in the heart. Why get sick? Why die?
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Comment by: Doug H (rural MN) Mon., Jul. 8, 2013 at 2:20 pm EDT
My doctor told me I had Hep. non A - non B in 1986. We tried several injections of gamma globulin and interferon through 1991. The liver enzymes were controlled. In about 1998 after returning to MN, physical symptoms appeared. A biopsy was done and I was diagnosed w/stage III Hep. C. After 15 months of Ribavirin and Alpha Interferon (hell!,) I've since been Hep. C free.For a variety of reasons I wasn't tested for HIV until 1987. I started HAART W/Trizivir, in 2000. HIV loads have been undect. w/cd4s mostly and still 1000-1200+. We estimate initial HIV infection to be c.1981.
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Replies to this comment:
Comment by: r.morales (walla walla) Tue., Sep. 17, 2013 at 5:17 pm EDT
wau 1000 to 1200 is fantastic congrats.


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