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it's impossible to determine the extent of damage that's been done. you can try and go through and patch it up as well as you can, but the problem is there's always the possibility you missed a tiny thing, and that's all it takes.
a clever hacker would put in registry entries to redo anything you do, as well as put in several backdoors and ways to access the system. anytime you reboot the machine you could be executing a sequence that will reopen the doors.
your SAFEST bet is to back everything up, and do a reinstall. that way you're sure you've gotten everything.
personally, this would be my FIRST resort. i consider myself adept at cleaning machines, but even i know that i'm not good enough to catch everything. so i know there's a likely probability i'd miss smething. i'd clean it up as best i can only if if there was a really good reason i shouldn't start from scratch.
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