"Overall one must not expect wonders from NTZ, but a robust helper role. If someone was a nonresponder with SOC, then the addition of NTZ in a new attempt is rather unlikely to push the deeply rooted inability of SOC to reduce the virus enough towards elimination to achieve SVR. It is important to have realistic expectations. Similarly, IMO, in such a particular case, the addition of the currently tested Polymerase inhibitors to SOC are not too promising to tilt the scale towards SVR"

HR - do you mean the polymerase inhibitors currently in clinical trials?  This is the first mention that I have heard that a combo of one of these plus SOC would not be effective enough for nonresponders.  Can you say more (in words that I can understand) about how you come to this opinion?  We are seeing some previous nonresponders do well with the Vertex triple therapy, although the final numbers are not yet in, so do you think that triple therapy with a protease inhibitor has a better chance of success?  Or is it that you are dubious about all triple therapy for non-responders, ie. that they would be better to wait for a combo of two active agents plus SOC?

Thanks
dointime  

HR - It is also true, that induction IFN therapy has not been as effective as some have hoped it could be.
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My understanding is that this was with non Peg IFN and Induction Dosing produced higher on treatment viral response but little or no difference in SVR. Higher relapse rates in other words. Now the investagors put this down to Induction dosing not working.
Me I thought its not the induction dose that didnt work but the switch back to TIW that didnt work.

Bit like deja vu with Peg Induction (whats old is new again) and produces higher on Tx VR but I believe that no conclusions have been drawn, yet.
CS

So your cholesterol went down due to interferon?  Interesting. I never really checked. I know mine has gone up quite a bit lately and I am concerned. Due to the FM, I had no appetite and don't eat that good Fiber One cereal I used to. Most likely a big problem. I still am on that Ensure for breakfast, not a great thing. I really want to start going back to a better diet. It has been such a long time!  I gave up the ice cream from tx, but now NO breakfast is not the answer. Pain has a way of one not wanting to eat, as well. My pain is in control, thank god, but my diet is abysmal. Lot's have asked about diet, as I have advocated for the supplements for anti fibrosis. I am the last person they should ask!  That is why I brought it up with HR. You are correct in stating that tx vs non tx is different for a diet due to the Riba absorbtion. I sure couldn't eat like HR, but would like a reasonable diet that is liver friendly. I like simple and easy, not books about prikins or Zone. I would prefer a confersation about what foods would be good. Can I eat a pizza? I don't eat bread or don't like pasta...I love veggies. Maybe another recipe thread would be good. I would love to see some simple way to get those good foods that are liver friendly into my system.

At least from one old thread, my understanding is that HR advocates more of a Zone (balanced) diet, as opposed to a very low fat diet like Pritikin which has total fat calories under 10% of total calories.

As far as treatment is concerned, with me and many others, an "optimum" diet was but an academic discussion, because the real problem was finding a palpable diet that one could both  figuratively and literally stomach.

In my case, Pritikin or not, I ate a relatively low-fat diet before treatment with plenty of fruits and vegetables and light on the saturated fats.

For reasons only known to the interferon gods, I could not stomach this type of diet on treatment and reverted back to the "comfort" foods of youth which were high in saturated fats. Of interest, and thankfully, my cholesterol dropped dramatically on this diet, but the reason was the interferon, not the diet.

Could hardly look at a vegetable or salad for the entire time treating. Now, that I'm off treatment, my taste buds and food cravings have returned to normal. Unfortunately, so did my cholesterol, but that's another story.

And then also the riba issue of better absorption with higher fat meals while treatment. So, while there may be something as the ideal on-treatment diet, for many the ideal diet is simply what works and keeps us on treatment. Before and after treatment is another issue.

-- Jim

I don't think we have had a good diet talk recently. Your's is interesting, as well as others experiences with food.  Perhaps we should look at what HR has said in the past, what we are doing now?  Fat vs non fat (I know HR is a non fat kind of guy!) but given the Ribavarin component, what can we do on tx to accomodate this factor, unlike my diet of ice cream!  I think this would be an interesting discussion that I think HR would hopefully respond to...  As his supplement diet is reproduced recently and I believe he approves, quite a bit, those of us that perhaps are introducing a new diet...perhaps need to look into the "principles in metabolism and physiology" to guide us in our diets into a long term change,  would like to know a bit more. Bringing  up some old threads that HR responded to, as I know he doesn't like to repeat what he has said before, will help us with this discussion.

My last post was not in response to HR's post as indeed it crossed with his.

However, I might address with HR, is some anecdotal dietary experience I"ve had with different diets and liver enzymes.

As mentioned previously, what I found out prior to treatment was that a very low-fat, low-protein diet like Pritkin -- under 10% fat, very little meat, and plenty of carbs -- brought my enzymes into normal range - while a more Zone-type diet (lower carbs, more protein), always raised my enzymes.

-- Jim

To be fair to recent discussions, what's actually  been "hashed" about lately is not whether prev non or slow responders might benefit from DD on re-treatmment, but whether RVR's who relapsed would best served by DD, in particular as a sole strategy, as opposed to let's say extending tx or other interventions.

To be fair to recent discussions, what's actually  been "hashed" about lately is not whether prev non or slow responders might benefit from DD on re-treatmment, but whether RVR's who relapsed would best served by DD, in particular as a sole strategy, as opposed to let's say extending tx or other interventions.

From what we know at this point there are no obvious problems to this starting mode ( like side effects/interference ) but the difficulty to convince your treater and get the additional medication and the realization that effectiveness is probably less than if one would have started from the beginning.

1 An incremental respsonse to IFN dose will be present in some patients and not in others, in particular if the lack of response lies mainly in an adaptation of the HCV species in that patient to the critical Tcell response  by stripping itself from all effective epitopes. The complexity of the antiviral immune mechanisms does not allow for simplified rules.

2.If someone really needs to treat, this approach is worth trying with careful monitoring. It is also true, that induction IFN therapy has not been as effective as some have hoped it could be.

3.The proper diet for liver patients needs careful conceptual introduction, that has been given in detail in previous discussions of this topic. It is not recipes, but principles of metabolism and physiology that need to be understood so as to guide a long term change in dietary habits that will introduce the least amount of burden/metabolic stress  to a partially damaged liver.

Do you see any obvious problems with starting Alinia mid-TX and for the last 12 weeks of a 67 week course?
Thanks,

A couple of questions;
1.  Do you think that non responders have a chance of double dosing (or more), as they didn't respond before? As Cancer patients get a much larger dose of INF, don't you think that some need a higher dose?  

2,  Do you think that slow responders (like me) may get a better response from INF doing DD, especially at first?  We have been hashing this out lately...

3. I have been getting lots of questions about diet, especially your diet. Granted, you do not have Hep C, but eat like a rabbit (sorry! lol) Do you have specific suggestions for those that are asking about diet, not the supplements?    

Thanks!  
Linda

If you are looking carefully at the Alinia presentation by Dr. Korba at the hepdart conference that proactive has provided somewhere below, you will see the important factoid, that testing the in vitro efficacy of NTZ against geno 1a and 1b showed a high inhibitory efficacy, thus we have now direct data to support at least reasonable expectations for similar efficiencies against genotype 1a and b in vivo. With all the usual reservations, this seems to be a bit of real good news.

Overall one must not expect wonders from NTZ, but a robust helper role. If someone was a nonresponder with SOC, then the addition of NTZ in a new attempt is rather unlikely to push the deeply rooted inability of SOC to reduce the virus enough towards elimination to achieve SVR. It is important to have realistic expectations. Similarly, IMO, in such a particular case, the addition of the currently tested Polymerase inhibitors to SOC are not too promising to tilt the scale towards SVR

There are no such news or info known to me. The facts are, that both riba and NTZ are absorbed better with food, thus there seem to be some passive transport activation processes at play for both drugs. The concept of taking them separately to avoid competition is purely one of simply avoiding any competition by design, with no neg effects otherwise, but  you showed that eating 4 meals is a problem , so that design is actually not feasable for you. But there is no particular reason/data  to believe that such competition indeed exists, in particular in light of the fact that the absorption enhancement by food points to fairly unspecific mechanisms of intestinal transport.