3 HCV LINKS - Anemia - Steatosis - Serum Markers Liver Architecture

1) http://www.medscape.com/viewarticle/550731?src=mp
Anemia Associated With Antiviral Therapy in Chronic Hepatitis C: Incidence, Risk Factors, and Impact on Treatment Response

2) http://www.medscape.com/viewarticle/550733?src=mp
Impact of Liver Steatosis on the Antiviral Response in the Hepatitis C Virus-Associated Chronic Hepatitis

3) http://www.medscape.com/viewarticle/550730?src=mp
Noninvasive Serum Markers in the Diagnosis of Structural Liver Damage in Chronic Hepatitis C Virus Infection

Mike

[Kalio1]

thanks for the informative links

[jmjm530]

Thanks. Again, a linear relationship between severe anemia and SVR, which probably accounts for the anecdotal reports that the worse your sides are on treatment, the better your chances of SVR -- at least for geno 1's. I wish more people would understand this and instead of celebrating a flat hemoglobin response early in treatment, take it as an early warning sign to get an immediate VL test and see if things are working or not, and if not, make the necessary adjustments. Tried to get this across to Americabo, below, but I guess now well enough.

-- Jim

[mikesimon]

You've probably read that renal sufficiency plays a role and for those with compromised renal function weight-dosing isn't necessarily the best approach to ribavirin dosing. Looking at blood levels is a better way to arrive at the proper dose. I don't recall whether this was mentioned in this article - I think I read it is a renal transplant article now that I think about it. I am also questioning why this even occurred to me now. But for those who have renal impairment or suspect that they may, this might help a bit. Mike

[jmjm530]

The Sweedish researches were playing with a pharmokinetic formula to replace basing riba dosing on weight. The formula played heavily on renal function. Their research is also of interest to folks with impaired kidneys because it also demonstrates that even kidney impaired patients can take ribavirin in doses adequate to SVR, albeit a much smaller dose. But renal function aside, there also seems to be variables independent of renal function that account for why one person requires "X" amount of riba and another "Y" to achieve the same drop in hemoglobin and/or serum ribavirin levels. Where this all comes out is that the only truly accurate way to see how much ribavirin is absorbed is to test it in the blood using HPLC (high prefomance liquid chromatogrphy) testing, that is not available in this country, in fact hardly available anywhere except in research studies. To me, this is another example of how Hep C patients are treated as second class citizens by the medical community. If Hep C was a more politically correct "cancer", then you could be sure our ribavirin dose -- among other things -- would be monitored using the best and latest means including HPLC testing.

-- Jim

[jmjm530]

I guess what I'm saying is that not only are the drugs we treat with crude, but so are the assembly line protocols used by most GI's, and even at the top hepatologist level, a lot is to be desired in terms of monitoring drug and viral load response. For whatever reason, what high-technology exists, seems to be more at the transplant level, but not before we get there. Hopefully, the newer drugs will soon make this all academic.

[mikesimon]

I wasn't aware that tests to measure ribavirin blood level aren't available. It doesn't seem like too challenging a task but perhaps it is when it comes to second class citizens. Thanks, Mike

[jmjm530]

As of a year ago they were only available in Europe. We have HPLC technology here, but it's not being used to test ribavirin levels in serum. Frankly, the doctors don't seem all that interested, content to rely on the weight-based dosing studies written by their American peers. Attention is now turned to the sexier new drugs anyway, but it's a shame as long as we're still using peg and riba, that the treatment isn't maximized.

-- Jim

[jmjm530]

I just skimmed it briefly but will go back. Probably should point out to those new to all this that liver "steatotis" is different from "fibrosis". One has to do with the amount of fat in the liver, the other the amount of damage. I assume they tested the variable independent of weight, as steatotis and an unfavorable bmi often go together, and bmi is also a factor in SVR.

-- Jim

[mikesimon]

I re-read all of the posted links, carefully this time, and my feeling is that the anemia article is the weakest followed by the serum marker article which I thought had some value. The steatosis was the most informative in my opinion and I think that a lot of people would find it helpful. Mike

[GoofyDad]

My intuition says is the steatotis that has the direct relationship with SVR and that BMI is indirect and tied through its relationship to steatotsis. Just a guess.