24 week labs/reduced riba

[skiyaltr]

Triple tx with incivek.  Partial responder in 2006.

Lab results last Friday; still UND; UND at 4, 12, and 24.

ALT/AST - 31/25
hgb - 13
plt - 117
ANC/WBC - 800/1.9

Riba was reduced at 4 weeks to 600 and have not increased.  HGB has been in the 10-11 mostly, 13 was a surprise.

I feel like I am managing as well as I can and it has to be the riba level; when I treated in 2006, I was at 1200 and also taking procrit.  By feeling better I am staying active and appetite is good.  

It is not without sides though; still tired, forgetful, crabby, etc.  This week noticing hair issues; I have normal wavy hair and it is flattening out; last tx, went completely flat.  New hair style is on the horizon.

While this is a status, I am posting on the medical side as know there are other people tracking riba tx levels.  At 13, I could increase Riba to 800, maybe 1000 and at the next appointment, see the drop, then reduce riba again.  That cycle makes it difficult to manage life.

My doctor treats a lot of hiv and hep-C patients and is comfortable with all the literature that when und at 4 week, reduced riba to 50% will not decrease chance of SVR.  

Thanks for all the support.

[frijole]

john
Welcome to this site.  There are a lot of great people here.  I cannot say what the ramifications are with you having had a failed femoral stint but you are through the hardest part - the Incevik part- and I hope you can and will continue.

Did you get a biopsy?  It sounds like you are good to go for 24 weeks of treatment unless you are cirrhotic.  A hearty congrats on all of those stacked up UNDs!

As far as navigation of the site -- or post goes, you can hit the reply buttom by someone's post but I normally just go to the end of the thread and enter in the comment box.  You can address more than one person that way instead of a separate comment for each person.



My HGB was at 8.9 last week.  If it goes down tomorrow, the doctor says I will have to do a transfusion.  I am hoping to avoid that but we shall see.  I am on Victrelis so am still continuing with the triple therapy and the combo of ribavirn and Vic is knocking me out!

[johnr1]

Hi there...Thanks for the note...I'm still not too good at figuring out this site.

I started back on the interferon 2 doses ago and also 600mg riba/day.
U nfortunately, my hg has dropped to 8.9 as of 6 days ago. Rbc down to 2.74. My doc is on vaca for another week+ and his fill in said to stop taking riba for 4 days and get another blood test in a week.
I don't think the fill in doc knows about my cardio history...frustrating.

I've never heard of procrit until coming on this site. My doc's office has heard of it ..but thats it.

I'm not sure what to do. I hate to quit tx...but I am concerned about a stroke.
I just hope your treatment is going better than mine is.

I appreciate the support. You guys are a positive in this thing.

[johnr1]

Thank you all for your input.
I did an interferon dose yesterday...about 27 hrs late..which I'm told is ok.
I was feeling a bit puny for a few days. I appreciate the support.
I've been on a ribavirin reduction (600 mg ) for a month. Started at 1200 in March ..went to 1000 and so on.
Blood work tomorrow...if Hg is mid tens...I think he's going to bump to 800mg riba.
I was "und" at 4 and 12 weeks...I believe if I'm "und" at 24 weeks...the protocol calls for stopping everything. (I'm a 1st timer).
Does anyone have any insight on any recent results?

Thanks again.
Good health!

[LookingForward12]

I would definitely start back  the interferon. From what I understand, post Incivek it is crucial to continue with interferon. Ribavirin can be dose adjusted and even halted for periods of time in the management of certain sides...anemia and rash. interferon can be reduced - mine was reduced for a total of five weeks of my last twelve, but never interrupted.
You can mak it these last few weeks with wise dose management. I would not, however, skip the interferon.

[BoceprevirGal]

If I were in your shoes I would restart.  Riba-reduction should be done before Interferon reduction,   It's the ribaviran that causes anemia, which in turn, can cause stroke, when in the 8's or lower~
   At 19 weeks, my doctor reduced my ribaviran, form 1,200 mgs, to 800 mgs,which made my anemia feel alot better

[johnr1]

Thank you for your kind response.
I've had most of the side effects with incivek, tho the rash and hemoglobin drop didn't get REAL bad until week 10. A blood transfusion got me thru.
Hg was at 8.7 and falling fast at the time of transfusion.

I'm now in week 15..my hg is 10.1
The fatigue, depression are still bad. The rash is improving. Yesterday, I skipped my first injection because of some severe stomach cramping for 4 hours and a cardio scare...shooting pains down left side and severe headache. They took me off HDL meds to start treatment. I have moderate to nasty lower body cardio vascular disease. I had a femoral stent 2 1/2 yrs ago...but it failed.

The peg-interferon med guide says take your dose within 2 days if you forget. I have 20 hours left to "restart". My gastro doc is a colon specialist and can't be reached. I'm his 3rd incivek patient. 50-50 on the first two patients.

If you were in my shoes, would you restart today?
I feel so much better today than I did yesterday.
I'm sooooo close...I hate to blow it...but I'm worried about a stroke.
What a mess.

Again, thank you for your consideration.I just logged in today. You folks are really good people. This thing ain't easy and I know people are being helped by your knowledge and experience.

johnr1

[willbb]

Do you think my chances of relapse are higher by skipping the last 9 weeks of inerferon and ribavirin?
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In a word "yes"

The prescribing protocols are based on what was the best outcome for patients  in the trials for these drugs . Anything less could very well decrease you chances of overall success for SVR

You say:
.
The side effects have almost hospitalized me 2 or 3 times including yesterday.
---------------------------------------------------
You don't mention what these are . Is your doctor not working with you to minimize these and if not he/she should be ..This is their job.

If the side effects are being managed to the best of their ability and still are  significant enough to be dangerous or life threathning then sometimes (albeit rarely ) one needs to cease tx.

it is never a good idea to kill the virus by killing the host  :)

If these side effects are managable and not threatning your well being I always say to someone considering quitiing .

"Do you think you will feel worse limping to the finish line or worse if you quit and relaspe because of  stopping  early..


Hope it works out and good luck

Will

[johnr1]

hi will
I was hoping to ask some advice.

I did the incivek triple therapy for 12 weeks to completion (needed a blood transfusion at 10 weeks due to anemia issues...great, huh).
I was undetectable at 4 and 12 weeks.
I skipped my ineterferon injection yesterday and discontinued the riba two doses ago. I am 3 weeks beyond incivek completion.
Do you think my chances of relapse are higher by skipping the last 9 weeks of inerferon and ribavirin?
The side effects have almost hospitalized me 2 or 3 times including yesterday.
Thanks to you and everyone for your valuable insights.
johnr1

[skiyaltr]

No dicussion yet; labs again 7/23; these were drawn 6/29.

[frijole]

Still, 13 is awfully high.  Will is correct, of course, but I would be tempted to increase the riba.  When I had insurance issues over the procrit I had to  reduce riba (from 1200) to 800 but I increased it when the HGB went back over 10;   Here close to the end, the procrit can't get me into the 10s and I have self-reduced the riba to 1000 for about the last month.  I don't think I could make it without doing that.

Are they holding tight with your ANC or is Neupogen on the horizon?

bean

[willbb]

My doctor treats a lot of hiv and hep-C patients and is comfortable with all the literature that when und at 4 week, reduced riba to 50% will not decrease chance of SVR.  
=-----------------------------------------------------

Your doctor is welll  informed.
You are doing great  .Good luck the rest of the way...

Will