Aa
First week of tx
Hi, I started tx this week of inf/rvb. Was wondering if this is pretty typical, I got my firt inf shot wens morning and felt ok all day. I had chills and fever at about 5:00 pm. Took a nap woke up feeling fine. Thursday felt great until afternoon then had some joint pain, especially in the lower back and knees. The rvb is not too bad it makes me a little itchy and feel kind of "up"?? When I feel good I feel better than I did befor tx and when I feel bad which isn't very often I feel just a little bit worse than I did before I started tx. What do you think? Is that a typical response for first week? Will things stay the same get better or worse as time goes by?
Thanks jen
Thanks jen
I had thought that the IL28BC elle marker had to do with the racial discrepency....75% of caucasions have a CC elle marker,(and this one is easiest to treat) but only 50% of African Americans have it. The TT marker is the one that is most treatment resistant...but I know, I know, the link, right?
Possibly the Op has received enough info. I believe he asked if chills and fever would continue.
Will
Will
Oh gosh, just checked the whole fat yogurt container, only 7 grams, although I've been eating two, and then a peanut butter sandwhich, with tons of peanut butter.. I had heard avocados, so I have 3 of them rotting my fridge, I've just been avoiding anything green these days...
But, like I said, you have to way advantages/disadvantages...with the individaul, and always check with yr Doctor. If you have diabetes, or a heart condition, or a weight problem, then that can change things. I'm just one of those freaks that can eat as much as I want, and I'm so hyper, that I'm hungry in another hour. It gets very costly...off to pick up burritos : )
Here's something on the Riba and high fat: "A high-fat meal increased relative bioavailability by a factor of 1.46, consistent with the value obtained from a previous noncompartmental analysis (Roche, data on file)."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1804105/
"Bioavailability of a single oral dose of Ribavirin was increased by co-administration with a high-fat meal. The absorption was slowed (Tmax was doubled) and the AUC0-192h and Cmax increased by 42% and 66%, respectively, when Ribavirin tablets were taken with a high-fat meal compared with fasting conditions [see Dosage and Administration (2.1) and Patient Counseling Information (17)]."
http://www.drugs.com/pro/ribavirin.html
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1804105/
"Bioavailability of a single oral dose of Ribavirin was increased by co-administration with a high-fat meal. The absorption was slowed (Tmax was doubled) and the AUC0-192h and Cmax increased by 42% and 66%, respectively, when Ribavirin tablets were taken with a high-fat meal compared with fasting conditions [see Dosage and Administration (2.1) and Patient Counseling Information (17)]."
http://www.drugs.com/pro/ribavirin.html
Vit D levels should always be kept at optimum levels as there is evidence of further advance progression of fibrosis when levels are unfavorable irregardless of being in therapy HCV therapy
http://www.ncbi.nlm.nih.gov/pubmed/22151003
Lower plasma 25-OH vitamin D levels were significantly associated with fibrosis progression >0.101 U/year in F0-2 patients (P = 0.013). Combined analysis of both variables revealed a highly significant additive effect on fibrosis progression with 45.5% rapid fibrosers for bAt[CCA]-haplotype and 25-OH vitamin D < 20 μg/L compared with only 9.1% for the most favourable combination (P = 0.006). In multivariate analysis, the bAt-haplotype was an independent risk factor for fibrosis progression (P = 0.001; OR = 2.83).
CONCLUSION:
Low 25-OH vitamin D plasma levels and the unfavourable VDR bAt[CCA]-haplotype are associated with rapid fibrosis progression in chronic HCV patients. In combination, both variables exert significant additive effects on fibrosis progression.
© 2011 John Wiley & Sons A/S.
http://www.ncbi.nlm.nih.gov/pubmed/22151003
Lower plasma 25-OH vitamin D levels were significantly associated with fibrosis progression >0.101 U/year in F0-2 patients (P = 0.013). Combined analysis of both variables revealed a highly significant additive effect on fibrosis progression with 45.5% rapid fibrosers for bAt[CCA]-haplotype and 25-OH vitamin D < 20 μg/L compared with only 9.1% for the most favourable combination (P = 0.006). In multivariate analysis, the bAt-haplotype was an independent risk factor for fibrosis progression (P = 0.001; OR = 2.83).
CONCLUSION:
Low 25-OH vitamin D plasma levels and the unfavourable VDR bAt[CCA]-haplotype are associated with rapid fibrosis progression in chronic HCV patients. In combination, both variables exert significant additive effects on fibrosis progression.
© 2011 John Wiley & Sons A/S.
Vitamin D Increases Sustained Response to Interferon-based Therapy for Hepatitis C, May Improve Liver Fibrosis
"In the EASL study, S. Abu Mouch and colleagues from Israel assessed whether adding a vitamin D supplement to standard hepatitis C therapy using pegylated interferon plus ribavirin could improve rates of sustained virological response (SVR), or continued undetectable HCV viral load 24 weeks after completion of treatment.
Vitamin D is a potent immune modulator that has a direct effect on T-cells and antigen-presenting immune cells, and can directly or indirectly influence the differentiation and activity of CD4 T-cells, the researchers noted as background. They hypothesized that vitamin D has an important role in innate immune response against HCV. In addition, some studies have shown that vitamin D improves insulin sensitivity (a predictor of better treatment response) and inhibits HCV replication.
The investigators first measured vitamin D levels in a group of 157 chronic hepatitis C patients treated at their liver clinic in Israel, and found that fully 84% had low levels, and one-third had "severe deficiency."
They then performed a randomized study of 67 patients. About half were men, the average age was 48 years, and most were of Russian origin, with only a few being of Israeli or Arabic origin.
Participants were randomly assigned to receive 1.5 mcg/kg pegylated interferon alfa-2b (PegIntron) plus 1000-1200 mg/daily weight-adjusted ribavirin for 48 weeks, with or without 1000-4000 IU/day vitamin D3, enough to bring serum levels up to 32 ng/mL. By chance, patients in the vitamin D group were more difficult to treat than those in the control group, having a higher body mass index and larger percentages with high baseline viral load and advanced liver fibrosis.
Results
44% of participants receiving vitamin D achieved rapid virological response (undetectable HCV at week 4), compared with 18% in the control group (P < 0.0001).
94% of participants in the vitamin D group achieved complete early virological response (undetectable HCV at week 12), compared with 48% in the control group (P < 0.0001).
85% of patients in the vitamin D group achieved SVR, compared with 43% in the control group (P < 0.001).
Adverse events were mostly mild and were typical of those associated with pegylated interferon/ribavirin (mainly flu-like symptoms).
No serious adverse events were reported.
These findings led the investigators to conclude that adding vitamin D supplements to pegylated interferon/ribavirin therapy for treatment-naive genotype 1 patients with chronic HCV infection significantly improves SVR rates.
They further suggested that vitamin D deficiency may contribute to the strong racial/ethnic disparity observed in responses to antiviral therapy for HCV. People of African descent -- and to a lesser extent Latinos -- do not respond as well as whites and Asians to interferon-based therapy.
People with darker skin produce less vitamin D when exposed to the sun, and are therefore more likely have low levels. The 2000-2004 National Health and Nutritional Examination Survey (NHANES), for example, found that U.S. non-Hispanic whites had average vitamin D levels nearly 10 nmol/L higher than those of Mexican-Americans, who in turn had average levels more than 10 nmol/L higher than non-Hispanic blacks."
http://www.hivandhepatitis.com/2010_conference/easl/docs/0518_2010_b.html
"In the EASL study, S. Abu Mouch and colleagues from Israel assessed whether adding a vitamin D supplement to standard hepatitis C therapy using pegylated interferon plus ribavirin could improve rates of sustained virological response (SVR), or continued undetectable HCV viral load 24 weeks after completion of treatment.
Vitamin D is a potent immune modulator that has a direct effect on T-cells and antigen-presenting immune cells, and can directly or indirectly influence the differentiation and activity of CD4 T-cells, the researchers noted as background. They hypothesized that vitamin D has an important role in innate immune response against HCV. In addition, some studies have shown that vitamin D improves insulin sensitivity (a predictor of better treatment response) and inhibits HCV replication.
The investigators first measured vitamin D levels in a group of 157 chronic hepatitis C patients treated at their liver clinic in Israel, and found that fully 84% had low levels, and one-third had "severe deficiency."
They then performed a randomized study of 67 patients. About half were men, the average age was 48 years, and most were of Russian origin, with only a few being of Israeli or Arabic origin.
Participants were randomly assigned to receive 1.5 mcg/kg pegylated interferon alfa-2b (PegIntron) plus 1000-1200 mg/daily weight-adjusted ribavirin for 48 weeks, with or without 1000-4000 IU/day vitamin D3, enough to bring serum levels up to 32 ng/mL. By chance, patients in the vitamin D group were more difficult to treat than those in the control group, having a higher body mass index and larger percentages with high baseline viral load and advanced liver fibrosis.
Results
44% of participants receiving vitamin D achieved rapid virological response (undetectable HCV at week 4), compared with 18% in the control group (P < 0.0001).
94% of participants in the vitamin D group achieved complete early virological response (undetectable HCV at week 12), compared with 48% in the control group (P < 0.0001).
85% of patients in the vitamin D group achieved SVR, compared with 43% in the control group (P < 0.001).
Adverse events were mostly mild and were typical of those associated with pegylated interferon/ribavirin (mainly flu-like symptoms).
No serious adverse events were reported.
These findings led the investigators to conclude that adding vitamin D supplements to pegylated interferon/ribavirin therapy for treatment-naive genotype 1 patients with chronic HCV infection significantly improves SVR rates.
They further suggested that vitamin D deficiency may contribute to the strong racial/ethnic disparity observed in responses to antiviral therapy for HCV. People of African descent -- and to a lesser extent Latinos -- do not respond as well as whites and Asians to interferon-based therapy.
People with darker skin produce less vitamin D when exposed to the sun, and are therefore more likely have low levels. The 2000-2004 National Health and Nutritional Examination Survey (NHANES), for example, found that U.S. non-Hispanic whites had average vitamin D levels nearly 10 nmol/L higher than those of Mexican-Americans, who in turn had average levels more than 10 nmol/L higher than non-Hispanic blacks."
http://www.hivandhepatitis.com/2010_conference/easl/docs/0518_2010_b.html
There is great news about vitamin D helping to achieve SVR.
My doctor says it's fine to take a multivitamin but to be sure to take one without iron, as too much iron is toxic to the liver.
He also told me to take calcium as tx is hard on the bones. This may vary according to your particular situation, age and sex.
It's true too much vitamin D can be toxic to the liver. My hepatologist has me taking 2000mg. I use a liquid dropper ( 5 drops=2000mg) because the multi- vitamin and calcium that I take also contain D. This way I can adjust how many drops of D, I use for the correct amount.
Vitamin-D: An innate antiviral agent suppressing Hepatitis C virus in human hepatocytes.
Vitamin-D supplementation was reported to improve the probability of achieving a sustained-virological-response when combined with antiviral treatment against Hepatitis C Virus (HCV).
http://www.ncbi.nlm.nih.gov/pubmed/21793032
epatology. 2011 Jul 25.
My doctor says it's fine to take a multivitamin but to be sure to take one without iron, as too much iron is toxic to the liver.
He also told me to take calcium as tx is hard on the bones. This may vary according to your particular situation, age and sex.
It's true too much vitamin D can be toxic to the liver. My hepatologist has me taking 2000mg. I use a liquid dropper ( 5 drops=2000mg) because the multi- vitamin and calcium that I take also contain D. This way I can adjust how many drops of D, I use for the correct amount.
Vitamin-D: An innate antiviral agent suppressing Hepatitis C virus in human hepatocytes.
Vitamin-D supplementation was reported to improve the probability of achieving a sustained-virological-response when combined with antiviral treatment against Hepatitis C Virus (HCV).
http://www.ncbi.nlm.nih.gov/pubmed/21793032
epatology. 2011 Jul 25.
"The ones that I know of, that are toxic to the liver, are vitamin D3"
"The vitamin D gets toxic at around 400 iu's"
Could you please post links that support this claim.
"The vitamin D gets toxic at around 400 iu's"
Could you please post links that support this claim.
http://www.spfiles.com/pipeg-intron.pdf
Effect of food on absorption of ribavirin:
Both AUC and C-MAX increased by seventy percent when Rebetol Capsules were administered with a high fat meal: (841 kcal, 53.8 g fat, 31.6 g protein, and 57.4 g carbohydrate) in a single-dose pharmacokinetic study
If you do the math you will have to eat 26.9 grams of fat with each dose for a 35% increase in absorbtion .
Effect of food on absorption of ribavirin:
Both AUC and C-MAX increased by seventy percent when Rebetol Capsules were administered with a high fat meal: (841 kcal, 53.8 g fat, 31.6 g protein, and 57.4 g carbohydrate) in a single-dose pharmacokinetic study
If you do the math you will have to eat 26.9 grams of fat with each dose for a 35% increase in absorbtion .
True, and the members here have kind of recommended I post a link to the stuff I spout out on here, so I will see if this riba w/ high fat is legitmate imfo, and be back. My Doctor did have me go off ALL my vitamins, so I followed her advice, because my liver enzymes were so elevated, she thought maybe the vitamins were making my liver toxic. The ones that I know of, that are toxic to the liver, are vitamin D3, especailly in high doses, and vitamin E should also be taken ion alow dose, and not everyday...I'm pretty sure. I am kind of lazy about this 'linking" of the imfo I read though....and I kind of have been cheating,m and taking a little bit of liquid vitamin D3 in a dropper, but only about 150 iu's. The vitamin D gets toxic at around 400 iu's but all of us have different livers, and it depends on what the biopsy says. My biopsy had me at stage 2 without any iron overload, but my platelets were low, and I was rly feelinglike crap, before treatment.
Now I feel much better : )
Now I feel much better : )
Yah I've heard people talking about high fat and also vitamins. What is that all about? My dr. Didn't say much when I asked.
I am going to get my 8th inf shot on tuesday. I definiteoy remember having this terrible ache in my lower back, and realized, Ihad been playing tennis, the day before the shot, and the interferon just seemed to make the slightly sore muscles SUPER sore. So....I stopped working out hard enough to break down my muscles, and just walk the dog, 3 times a day, which got rid of the achey muscles. I'm not sureif it's the infor the riba that give meinsomnia, but yeah, I do feel "up" as you say.
I feel better also, that's a good sign for you, that you feel better, and also, that the interferon is making you achey, it means your body is responding to the interferon, which we want it to be doing...good luck! Oh, P.S., I have hear the Riba is better absorbedinto the body, with high fat, so I switched my milk my dairy products, from low fat to whole milk, and half and half in my coffee, and it is working well for me, but then again, I dont put on weight so each personis different this way ; )
I feel better also, that's a good sign for you, that you feel better, and also, that the interferon is making you achey, it means your body is responding to the interferon, which we want it to be doing...good luck! Oh, P.S., I have hear the Riba is better absorbedinto the body, with high fat, so I switched my milk my dairy products, from low fat to whole milk, and half and half in my coffee, and it is working well for me, but then again, I dont put on weight so each personis different this way ; )
Hello and welcome to the forum.
Your reactions are pretty typical. Everyone reacts a little differently to the medications. Some have few side effects and others have more. It sounds like you are only on Inf and Riba, which helps. The triple med treatment often has more side effects.
No one can predict how you will feel in a week or two or four or eight. Some side effects tend to lessen, but other side effects tend to creep up on a person. They can get cumulative. How you feel will also depend on if your blood counts drop significantly. You will feel much more tired if you become anemic.
It sounds like you are doing very well. Hopefully your treatment will go smoothly and you will have few side effects.
Your reactions are pretty typical. Everyone reacts a little differently to the medications. Some have few side effects and others have more. It sounds like you are only on Inf and Riba, which helps. The triple med treatment often has more side effects.
No one can predict how you will feel in a week or two or four or eight. Some side effects tend to lessen, but other side effects tend to creep up on a person. They can get cumulative. How you feel will also depend on if your blood counts drop significantly. You will feel much more tired if you become anemic.
It sounds like you are doing very well. Hopefully your treatment will go smoothly and you will have few side effects.
Hi jen, first welcome to the forum and congrats on getting started. This will likely be a journey with several surprises and maybe a few rough patches. Some breeze through tx and others have a rough time, so its very difficult to predict what might be ahead of you. It does take several weeks for the meds to saturate your body and blood cells, so I'd expect you'll continue to experience some increasing fatigue as the 2nd and 3rd week approaches. Best of luck to you and hope you have a smooth ride. They are many great people on this forum willing to assist, so don't hesitate to ask questions as they come up. Good luck to you. ;)
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