Calling all breakthrough'ers - did high-dosing riba get you SVR next time around?

Hi All,

My doc said I had breakthrough because of not enough riba in my blood serum after dosing 1200mg daily.  But I just read on another thread about some people who high-dosed riba and still got breakthrough.

I'm wondering if there are people who can eat riba all day and still not enough gets into their blood.  My blood cholesterol is naturally low.  There have been suggestions on other threads that high blood cholesterol is helpful to SVR.  Maybe that's what determines how much riba ends up in the blood plasma and subsequently correlates with SVR.

If my body won't absorb riba to effective levels (ignoring the rash issue for the moment) then it's worrying.  Would that mean I have to wait for a tx that doesn't need riba to work.  That could be a long wait.

Any thoughts please?
dointime.

  

    

[Proactive]

Will be interesting to see the results of this study (although it's for coinfection)
http://clinicaltrials.gov/ct/show/NCT00470210;jsessionid=662F37FDD8FD175522A19D6F3E828041?order=3

[Proactive]

"b.     Ribavirin with Erythropoietin (Epoetin)
Anaemia is the most problematic side effect of ribavirin. It can often lead to the need to reduce the dose or abandon treatment with ribavirin altogether. The use of the drug epoetin in conjunction with peg-interferon and high doses of ribavirin has been shown to reduce anaemia and the need for ribavirin dose reductions, which in turn leads to higher SVRs. In a study evaluating high dose ribavirin with epoetin it was found that patients who received high dose ribavirin had a significant increase in SVR over those receiving the standard dose, from 34% to 49%. This increase in SVR was the result of a marked reduction in the incidence of relapse, dropping from about 36% to 9%.
Recent studies have also indicated that high doses of ribavirin with epoetin increases SVR in people with genotype 1."
http://www.hepcuk.info/data/usercontentroot/home/treatments/Retreatment.asp
while not hep c related interesting article on intravenous administration of riba for Subacute sclerosing panencephalitis
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=90399

[susan400]

I was on 1600mg a day and I still did not get SVR.  But, I wouldn't use my case as a good example as I have a lot of resistance built up from all my treatments.  

Susan

[zazza]

There is a difference between viral breakthrough and non-response. Viral breakthrough means you have at one time become UND and then, while still on tx, the test results show you have a viral load once again.

My take on this is that ribavirin reduces the risk for relapse and viral breakthrough. A too low dose of ribavirin might not be sufficient to prevent viral breakthrough.

I have also seen threads lately by people with high dose riba whose tx was unsuccessful, but were not these people non-responders, i e not UND by week 24? Susan, were you a non-responder?

[dointime]

That's a good point zazza.  I did get to UND before the breakthrough.  I was on 1200mg riba with my weight just borderline high enough to justify that dose, and I was fully compliant, so I shouldn't have had breakthrough unless:-
-
I have a very resistant virus (I think I probably do have the virus from hell), or
-
My riba absorbtion is poor, ie. not high enough riba concentration in my blood serum.  My hgb never dropped below 12 on tx so that might be an indicator.

So what do you reckon are the chances that in my case a high-dose riba strategy would prevent breakthrough next time?
-----------------------
Susan - I would be so scared to take 1600mg riba because of the rash.  Did you have worse rash problems with increased dose?  How long were you on that dose?  I am very sorry you had to go through all that.          
-----------------------
Proactive - many thanks to all the informative links you posted.  

    

[susan400]

I've always been considered a non-responder as opposed to a relapser.  This is because I've never had any labwork coming back with the words, "undetected" on it.  I've always had virus detected ever since I did my 1st round of treatment and I've done this 9 times now, after adding the Prove 3 to my list of failed treatments.   I get some response, but never undetected.  In order to be called a relapser, or viral breakthrough, you have to have cleared in the first place.   I have no idea on the Prove 3 whether or not I ever had viral clearance, because I have not been unblinded yet.  All I know is that the virus rebounded at some point in the 5 weeks that I was on it.  I have a feeling that since I was not on the Ribavirin, but only the Telaprevir and Pegasys that I never cleared.  I think that what probably happened was that my viral load dropped down low-didn't clear and then, jumped back up, sometime during the course of the 5 week time frame.  I think, or feel at this point, that it's going to take a mighty work of God for me, for any of these meds to work.  I've got such a resistance going on.  

Susan

[zazza]

Here is a link to a special edition of  the journal Medical Crossfire about chronic hepatitis C:

http://www.medicalcrossfire.com/online_learning/cme/06-LC-27-M-100.pdf

Its subtitle is "Strategies for Optimizing Current Treatment and the Potential Impact of Emerging Therapies". There is a section inside called "Improving Response in the Setting of Treatment Failure".

Non-response is divided into 3 different types: null response, partial response, breakthrough response.

I found it an interesting read, and a good overview.

[zazza]

Susan and dointime,
I admire the strength and courage you both have shown in fighting this virus. You have fought with the odds against you. I so wish you will both find the way to SVR. Zazza

[dointime]

Great link, thanks for posting,
dt

[CockSparrow]

Thank for posting the link, I also found it an interesting read, even if i found myself not agreeing with everything.
One of the things i liked was being able to see the faces of such well known names.

There was however one thing that stood out over everything else.
What the h=ll was Shiffman thinking when he grew that Mo.

CS

[zazza]

LOL!