Dr. Gish says maybe we can shorten treatment

[debnevada]

Interesting development and quite surprising.

I was contacting Dr. Gish about studies for co-infected non-tx-naive sufferers yesterday  for a friend of mine on the boards and he had one of his MDs do the research. They are not doing at CPMC, sad to say.

Also, at the same time, Dr. Gish asked me to keep in touch more oten, so I sent him an email with my current status, all details. I believe he and my internist had spoken regarding the delusions issue a couple of weeks ago.  I also asked him if it would be possible to shorten treatment based on my acute illness, VL never greater than 42,000 and so on.

His response was to thank me for my update and also this
"we can definitely shorten treatment if your side effects continue.
Let us discuss q. four weeks"

I hate the treatment, although I'm not sure how to react to this. Is he giving me what i want?  What is the algorithm here? Part of me is overjoyed and part of me is going...is this a side effect "give up"?

I hope ya'll don't mind me posting this today....it is a tough day on the board, but I wouldn't mind opinions, especially JMJM and his cohorts (wise experienced sages).

I'm so weird, i know.

Deb

[katerika]

Thanks
I am geno 1 Biopsy  states stage 3-4/4 grade 2/4. I also have NASH the biopsy states" LIVER PARENCHYMA  with portal lymphotic aggregates, mild lobular inflamation and mild piecemeal necrosis. Moderate to severe steatosis, ballooning degeneration of hepatocytes and scattered hepatpcytes with glycogenated nuclei are noted

[jmjm530]

Not familiar with Metformin, nor how the increase in interferon relates to your weight. (More familiar with Pegasys, one-weight-for-all). That said, have you discussed upping the ribavirin with your doctor? A lot depends on how much riba you're on now, what you weigh, what was your hgb drop and how you feel. Also, if you've been given -- or would be given -- the helper drug Procrit. Is your doctor a liver specialist(hepatologist)? In general, they are the best to supervise treatment, but even much more so when you start to deviate (customize) from SOC. You want to do everything reasonable to get UND by week 24 or your chances of SVR are extremely low.

All the best,

-- Jim

[mikesimon]

I am not aware of any contraindication for Metformin while on interferon/ribavirin. I believe that at one point I was taking that drug while treating but I'm not certain about that. Have you been diagnosed with NASH? I am not knowledgeable about NASH because that is one of the few diseases I haven't been afflicted with.

Evidence for a role of nonalcoholic steatohepatitis in hepatitis C: A prospective study.
Bedossa P, Moucari R, Chelbi E, Asselah T, Paradis V, Vidaud M, Cazals-Hatem D, Boyer N, Valla D, Marcellin P.

Service d'Anatomie Pathologique and CNRS UMR 8149, France.

Although steatosis is a common histological feature in chronic hepatitis C (CHC), nonalcoholic steatohepatitis (NASH) has not yet been clearly characterized in this context. The aim of this prospective study was to investigate the characteristics of patients with NASH and CHC. Biopsies were categorized as CHC alone (178 patients [57%]), CHC+steatosis (94 patients [34%]), or CHC+NASH (24 patients [9%]). Patients with CHC+NASH had significantly higher AST and triglyceride levels and lower high-density lipoprotein (HDL) cholesterol or total cholesterol than patients with CHC+steatosis. They also showed more steatosis and higher METAVIR fibrosis stage than patients with CHC+steatosis. Genotype 3 was more frequent in patients with CHC+NASH than in patients with CHC+steatosis or CHC alone. Patients with genotype 3 and CHC+NASH were similar to those with CHC+steatosis or with CHC alone according to triglyceride or the homeostasis model for assessment of insulin resistance (HOMA-IR), whereas in patients with genotype 1, HOMA-IR and triglyceride increased progressively from CHC alone to CHC+steatosis to CHC+NASH. In multivariate analysis, triglyceride and HDL cholesterol were predictors of NASH in patients with genotype 1, whereas in patients with genotype 3, AST was the only predictor. Conclusion: Patients with CHC+NASH differ significantly from those with CHC+steatosis and CHC alone in terms of biological and metabolic parameters and more advanced histopathological lesions. NASH is more common in genotype 3 and is not associated with metabolic dysfunctions in this subgroup, suggesting that NASH may complicate steatosis in CHC irrespective of etiology of steatosis. (HEPATOLOGY 2007.).

Also check out the Clinical Care Options website for additional information on NASH I'm sorry that I can not be of more help right now.

Mike

[orphanedhawk]

My Gish group guy, was flexible with the amount of time I did tx. He wanted 12 months initially. Then, 9 months after UND. I landed up doing 32 weeks and he felt fine with that. Be glad that Gish is flexible. And I would indeed e-mail him with all your sxs.

BTW: When I told my dr. that I couldn't do 12 months, he didn't ask why. He assumed it was because of sides. My reason was because the neupogen was driving me nuts!

I think statistically, we all are more likely to get SVR by doing longer tx. This looks good  for the docs who can then use those numbers to their advantage, perhaps for further funding for thier research?

This doesn't mean they don't know their stuff, but there is more unknowns here than known.
I'd suggest asking Dr. Gish for the statistical differences, if you stop now or continue.
     Good luck, I know these are tough decisions.                 OH

[katerika]

Sorry for pokinging into your thread,
Just got back from the DR. decision to up Interferon to 150. We talked about adding Metformin for insulin resistance or upping Interferon. I said I didn't think I needed more side effects, I am to call her with decision tomorrow.  She called and left a message Metformin and Tx combined doesn't look like an option. So I think upping the dose, original gut feleing is the best. Any ideas on NASH, my triglycerides are all good and have always been weel below limits. My Iron levels are always up. I do feel a need to tx this, but thus farnot much tx. out there. Any ideas of a NASH specialist.
Well thats it. Oh for backround info my
Original VL was 2 million IU  / 10 million copies
4 week PCR = 397888*


8/15 Quanative Hep O RNA  [ref range <1.9]        4.3 HF@
12 week  = 19900
15 weeks   5000
Thanks In advance.
Teri

[mikesimon]

I think Jim nailed it when he said: "but what it really comes down to is that they just don't know...". I would guess that you are familiar with the same studies that he is as well as the studies that he has been associated with and, in the final analysis, shorter is better ONLY IF it works. We do know that your chances of achieving SVR are certainly not diminished if you treat longer and they are likely improved - it's the sides and what these drugs may do to you that argue against longer treatment. And no one knows that either in the majority of cases - how treatment will affect you in the long run. You place your bet and take your chances. There is no magic answer to this stuff for most of us. Good luck, Mike