Abstract

AIDS: Dr. Douglas Dieterich, a gastroenterologist and Associate Professor of Medicine at New York University School of Medicine, is a director of a American Foundation for AIDS Research-sponsored clinical trial for people with hepatitis C and HIV. Dr. Dieterich suggests that individuals who use intravenous drugs, those with a family history of hepatitis C, or those who received a blood transfusion prior to 1990 get a hepatitis antibody test followed by a hepatitis C PCR test to detect the infection. Up to 40 percent of HIV-positive individuals also have hepatitis C, however many patients go undiagnosed. Dr. Dieterich recommends a more aggressive treatment approach for HIV-positive individuals, including a liver biopsy to determine the degree of cirrhosis. The Food and Drug Administration (FDA) advises that patients who were previously treated for hepatitis C with alpha interferon alone should be re-treated with interferon plus ribavirin. However, caution must be used in treating people with advanced hepatitis, who will initially worsen with interferon treatment. Patients with coronary artery disease need to have a stress test prior to taking ribavirin. Side effects experienced with alpha interferon are numerous but not serious and are manageable with non-prescription medicines. According to Dr. Dieterich, choosing a physician to treat hepatitis C should not be limited to gastroenterologists, but should also include specialists in infectious diseases, internists, and primary care physicians specializing in HIV.