The following is a physician-patient interaction that took place within TheBody.com's "Ask the Experts" forum on hepatitis.
|Question about treatment for Hep C
Jan 26, 2014
My new HIV doctor wants to treat my Hep C. I learned I had HIV/Hep C in 1988. My hep c was dormant till recently. My old HIV docs didn't want to treat me with interferon/ribavirin because of past problems with many drugs. They were concerned I couldn't tolerate it. I have allergies to many meds like acyclovir, famvir, bactrim, Atripla, diflucan, etc. etc. I took norvir/lexiva/truvada for almost 2 years and my liver nearly failed because of that combo. They stopped all meds until liver counts fell a bit and started isentress/truvada and I've been okay for about 2 years but liver counts are rising again. I'm terrified of interferon for many reasons but mainly my past problems with meds. I had a liver biopsy a few years back and they were reluctant to medicate me with morphine because of a previous liver biopsy where I broke out in hives during the procedure. They used instead, fentanol? but I felt everything (brutally painful) and it took 2 weeks to recover before I could sleep even laying on my back. So I refuse to have another biopsy period. I was hoping to be a candidate for the newer drugs recently approved for Hep C but a study where I live says you must have tried and failed interferon before doing the new meds so I think I might have to give this a try. Can I ask here for a second opinion? Will I be able to tolerate these meds without dying because of them? I sometimes think my body is just tired of all the meds I've put into it over the last 25 years and I haven't fought this hard and this long to lose the battle now. Thank you for your help.
| Response from Dr. Taylor
The benefits of achieving a cure with the new hepatitis C medications that may be used without interferon outweigh the risks for people living with both HIV and hepatitis C. Your body will suffer more if you developed advanced liver disease or liver cancer than it will from taking the new pills.
There are many new pills coming out that can cure hepatitis C without interferon. The best treatment choice depends on your genotype. Ask your doctor about sofosbuvir and stay in close touch with your doctors over the coming months as new pills become available in some parts of the world. Unfortunately it will take longer for the newer safer more effective pills to be available in less resourced parts of the world.
You do not need a liver biopsy in order to be treated for hepatitis C. The biopsy may provide information that can be helpful in guiding decisions but it is not necessary. Especially for people with both HIV and hepatitis C, pills alone without interferon may be used without having people have a biopsy. There are blood tests and other ways that your doctors can assess how much scarring is in the liver. The amount of scarring in the liver helps us make decisions about whether we need treatment right now or can wait for even better therapies in the future.
Remember that hepatitis C does not have a 'dormant' phase. Scarring can progress even when we do not have any symptoms. In some people the scarring is a very slow process. People whose scarring proceeds most slowing include those with well-controlled HIV, people who do not use alcohol, people without fatty liver disease.
I understand and respect your concern about interferon. Talk with your doctors about interferon-free options to cure your hepatitis C.
Isentress/truvada is a very, very liver-friendly HIV regimen, how wonderful that you are taking these medications.
Any person may ask for a second opinion. When you have concerns about the information you are receiving if possible a second opinion can be helpful.
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