News Stories

[TnHepGuy_]

<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15155230">Mutations conferring resistance to a potent hepatitis C virus serine protease inhibitor (BILN 2061) in vitro</a>

<a href="http://www.hivandhepatitis.com/hep_c/news/2004/060404_d.html">Peginterferon Alfa-2b (Peg-Intron) plus Ribavirin Treatment in Previously Untreated Patients Infected with HCV Genotype 2 or 3</a>

<a href="http://www.hivandhepatitis.com/2004icr/ddw2004/docs/0604/060404_c.html">Confounding Finding of Lower Rates of Histologic Progression in HCV-HIV Coinfected Patients Versus HCV Mono-infected Inmates</a>

<a href="http://www.hivandhepatitis.com/2004icr/ddw2004/docs/0604/060404_b.html">Switching from Peginterferon Alfa-2b (Peg-Intron) for Recurrent HCV to an Escalating Peginterferon Alfa-2a (Pegasys) Regimen May Improve Tolerability Post Liver Transplantation</a>

<a href="http://www.hivandhepatitis.com/2004icr/ddw2004/docs/0604/060404_a.html">The Majority of HCV Mono-infected Patients Are Not Suitable Candidates for Interferon and Ribavirin Therapy, and HIV-HCV Coinfected Individuals Are Even Less Likely to Be Eligible</a>

<a href="http://www.hivandhepatitis.com/2004icr/ddw2004/docs/0607/060704_d.html">Antioxidant Treatment Does Not Substantially Counter the Fall in Hemoglobin in HCV Patients Treated with Pegylated Interferon Alfa-2b (Peg-Intron) and Ribavirin</a>

[lost and confussed]

rev havent read all through this but I will tonight. Thanks for posting. from what I've read so far I'm just going to say that I have been on overload lately and been forgetting some little stuff.

Debra,
Thanks for thinking of me, I went to work today and put in 12 hours. just a little tired now. nothing that a good dinner and a bunch of water wont fix. Please if you are not already start drinking water it really helps as the more I drank the better I feel. Doc said to drink half your body weight in ounces per day or more if I could handle it. I am so proud of you for starting. Have you had your shot class yet? You will do fine sweetie. Really didn't feel the needle, I was just stupid about the day after Tylenol I did take 2 tylenol pm's b4 shot and slept well that night. Sunday and today no Tylenol had a minor headache but nothing that I couldn't deal with. Please let me know how you are doing.

oops dont know why this picked up old nickname but its me gonagetbetr. Without the support of everyone here I'd probably still be lost

[cornsqueezer]

I am so glad to see your feeling better, I was worried
about you. Take it easy on yourself.....I know your so  
glad to get that first shot behind you, I can't wait till
Fri. to do the same.

Debra

[gonagetbetr]

Thanks so much you really cleared it up for me I thought I had lost it completely. glad to see that that wont happen right away lol still have many weeks to go.

Called doc this am and he is going to increase after the 2 week blood test if numbers are ok
he said that he wouldnt worry too much unless platelets get to around 30thousand.
he just wanted to see how I react to the first 2 shots
faxed other article to the cardio doc he said he may increase the heart meds a little to be careful
I should send you there names so you can bill them for consult
you are a gods send
thanks for all your help dont know how would have gotten through the last few months without you and everyone else's help and words of wisdom.
this forum should be included with the hcv positive results that docs give everyone so they are not as lost as I was in the begining.

I wonder about the whole loss of memory thing also does hcv have anything to do with memory or is it all these meds that I am taking that i never took prior. just curious if hcv affects the mind.

[TnHepGuy_]

Actually, you are comprehending just fine. They really don't spell it out too well in the article. The study looked at the records of 721 patients that were treated at one hospital - 22 of whom started tx with a platelet count of <80. The 721 pool of subjects were treated with either Peg-Intron (1.5) plus riba or the older non-pegalyated interferon plus riba (and the riba amounts ranged from 800 -1,400 mg/day). So this study isn't looking at differing dosage amounts or different types of interferon. They just used data from patients who were on those two different kinds when gathering up an overall pool of patients to choose from. What they ended up doing was to look at the 22 member low-platelet patient 'study group' and a 45 member 'control group' (chosen from the 721 patient pool), who didn't have low platelets to begin.


The results showed:

- that study group showed a 30% average drop in platelets over the 12 week period.

- 36% in the study group started off tx at a lower-dosage amount (similar to what you are doing).

- 55% of the study group had dose reduction during the 12 weeks vs. 22% of the control group.

- 32% of the study group had an early viral response (defined as a 100-fold or greater drop from their starting viral load amount by week 12 of their tx). 49% of the control group had an EVR.


Based upon these findings, they concluded that:

"<i>Combination therapy for chronic hepatitis C patients with significant pretreatment thrombocytopenia can be offered; however frequent dosage reduction may be required and may result in a lower rate of early viral response....Furthermore life-threatening complications may develop during therapy...</i>"



So, your doctor seems to be following along a similar path with you - being cautious at first to track how you respond to the medications. Hopefully you'll be able to tolerate them well.


I'm glad to hear you are feeling good. Keep the fluid intake up - it really does make a world of difference while on this stuff.


TnHepGuy

[gonagetbetr]

Tri,
Thank you for the articles. I did read them yesterday but spent the whole day trying to do the things that I usually do in 2 days in 1. I am feeling much better today thanks for asking.
I have read the article regarding the platelets 6 times ok I am not comprehending. I can not seem to find the the difference in the doses between the study group and the control group. I am probably reading right past it but if you can help i would appreciate it

I am feeling better today, Sunday was pretty good but I think I overdid it. tried to do 2 days worth of weekend work in 1 day.
There is a lesson well learned

Chevy,
Well you are almost done with tx now arent you? how many shots do you have left 3?
Hope you are still feeling ok. when do get your new kitty?

[Indiana]

Great info and food for thought from TnHepGuy....as usual.
I must say that I am VERY skeptical of that paper on fibrosis vs Svr rates. First off we all know that the old 3x/week interferon is NOT effective for geno 1's. I waited for the Peg to be approved for just that reason. That 3x/week stuff is LESS than 10% effective for geno 1's. That in itself makes this study suspicious. And also the Svr rates they cite cannot be used as true "Odds" for our purposes for this same reason.
Then I don't see where they accounted for age of the length of time the folks have had Hcv. Both of these factors have been repearedly shown to be factors in Svr rates. All the previous credible studies I have ever read have shown that damage levels below Cirrhosis levels have not been a factor in Svr rates. All cite age,gender,time you've had Hcv,weight,and other things as being far more likely to effect Svr rates than anything else.
I would really like to see the whole study and not just an abstract on this before I believe that fibrosis effects Svr as much as they state.

They link that really got to me in all those was the one about "The majority of patients not being "suitable" candidates for tx". GADS that pissed me off! Not SUITABLE?? The more I read the hotter I got. They cite the biggest reasons as low income and "Doctors Opinion". ACCKKKKK!!!! To me, that says that way too many doctors don't take this seriously enough and that we have no safety net for the low income folks who can just be left to die??  I am Soooo pissed I can't even see straight now. It also said that about 1/3 of patients declined tx on their own from fear of the side effects. That doesn't bother me as the decision was left up to them and we all must have the right to choose for ourselves. Better not to even start tx if one can't really commit to it. While I agree that education is the key to all this, I think that it is the doctors and politicians that control the funding who need the education rather than just the general public. Unfortunately, far too many of both think they already know everything and are not open to changing their pre-formed opinions on any subject.
Ok....I'm done "Venting".
I'm gonna go break something now.
Maybe if I try to break some "Tupperwear" it will give me time to get it ALL outa my system. Hahahahahahahahaha

[snook_man]

Here is link to FDA study that compares SVR rates, and factors of pegysus tx. In the study of us, and non us, it was based solely on geno 1..
http://www.hepatitisdoctor.com/Pegasys%20FDA%20data.html

I found the link on www.hepatitisdoctor.com, then click link for FDA fact sheet for pegysus.

[cornsqueezer]

Thank's for all the great info... now I have an excuse not to work lots of reading to do. lol!!!!!

                      Debra

[TnHepGuy_]

<u>snook-man</u> - Looking at the data he has listed:

- SVR rates for US geno 1's list a rate of 31% - and an overall US rate of 42%, when including all genotypes. These numbers are rather low and might be based upon limted data points (only 128 US geno 1's in the study) and/or perhaps upon riba amounts than used today. All the most recent studies I have seen put the geno 1 figure around the 50% mark and overall rates around 60% - including trials held in the US - though I'm sorry to say I don't have any of those particular studies handy at the moment.


<u>mikesimon</u> - is June 20th going to be tx finito? How often will they be doing blood work afterwards? And how soon will your first PCR be?


TnHepGuy

[TnHepGuy_]

<u>snookman</u> - above should have read:

...These numbers are rather low and might be based upon limted data points (only 128 US geno 1's in the study) and/or perhaps upon <b>lower</b> riba amounts than used today."

[mikesimon]

June 20th is the day...but since I take the shot on Sunday I am wondering if I will do the shot and follow up with a week of ribavirin or just skip the shot and quit. It's probably foolish at this point to worry about another shot and week of ribavirin but I really, really, really don't want to relapse and it's making me a little crazy. I'll figure it out and proclain the end date in bold type. Thanks for thinking about me. Good luck and be well. Mike

[mikesimon]

Sorry, I forgot the rest of your post. I can get a Heptimax whenever I want. Now I do the labs and Heptimax monthly and I'll probably continue on that schedule. I won't wait more than 1 month for the Heptimax, that is for sure. I think if I get past a month clear I'll be looking pretty good. Mike

[mikesimon]

Thanks for the info. It is much appreciated. Mike

[snook_man]

Tnhepguy: Thanks, I did read his #'s as being lower than what you can find listed today. But those #'s where part of study using 180 peg 2a a week, and either 1000, or 1200 mg riba, for 48 weeks. I believe that that is the standard dosing for pegysus and copeg.It may prove that his lower dose start, and gradual increase approach is not as successful as standard bite down and hold on full dose treatments

Revenire: I understand now. Forgot about the whole alien subspecies thing?

[Med Help]

Nice list of links to excellent Hep. information.  Thanks for taking the time to post all of these!!

Cindy Thompson
Med Help International

[couchpotato]

Bless you for finding and spending all the time it must take to search out all the information you provide us. Thank you, Couch

[cuteus]

i came accross this article and don't remember if you posted a link or not. have you read it?
www.natap.org/2003/Jan/010103_3.htm

couch; life is too short and precious to spend it dwelling in pettiness. I don't always remember this and let the "dark side"  tempt the Jedi in me. The fog is a mixed blessing, can't remember what happened two minutes ago, let alone days...
I am sorry but I could not remember(no surprise there) if your hubby was also in tx, if he is, then I will mention a little theory of mine from something that happened to me and another person here(can't remember who though).

This is getting worrisome; it seems that, I can't remember and i forgot, have become staple vocab. in my life lately.

[couchpotato]

Does that mean you saw my apology under the post Ringading sent to me? I was hoping you wouldn't miss it, and I am again sorry. Maybe I have been aflicted with a bit of Riba Rage, but no, no excuses, I was rude and it really was uncalled for. My husband was taken off tx in Feb. but I would like to hear your theory, could be interesting, especially if it is sprinkled with some Phog!!!!!!!!! Couch

[cuteus]

Yes, i saw it, but even without that I was not going to miss giving you a little support when your spirits needed lifting.  I am sorry written words can get so many interpretations that I am not intending.  I have learned to like everyone's style, even when i don't agree, riba might have given me impatience, but that has led to forcing myself to be tolerant, it takes energy, lots.
My theory, but I am not sure if it could apply, unless he was on tx for at least 6 months, or maybe in sensitive individuals it could apply.
about 6 months into tx or more, i developed a swelling and redness in the eyelids, that did not go away for months, until I treated a recurrent urinary tract infection with cipro, i mentioned that fact here, and I think it might have been ccgirl who chimed that hers cleared after going on antibiotics for something else. I did some search online and found some bacterial infection that can begin in the bowels or urinary tract and become systemic to the point of causing arthritis like symptoms.  here is the fog...can't remember the disorder right now, since i bookmarked it at work. Recently, The UTI came back and some mild eyelid itching with it.
I started the profilactic antibiotic I was given and the eye thing went away.
  I got to thinking if somehow the meds and its effect on the blood count opened the door for a systemic low key infection and that perhaps the only way to detect it, as suggested in the article, is with a blood or tissue culture.  It was disturbing.  It might explain some of the problems that don't seem to clear no matter what we do.  I kept telling my GI something systemic was going on, to no avail.  It might not explain things in his case, but it is somthing others can keep an eye on, fever is not always present in these infections.
ok, now brain hurts from exertion.
Please try to rest, this tx plus stress will wipe you out, ask befud. I don't want you sick also.

[couchpotato]

One last posting and then it is to bed for me. He was only on tx for a few months, taken off because of platelet problems. This infection came on really suddenly and hit him hard. The internist assured us that it is not related to his cirrhosis (the ultra sound showed no ascites) but maybe because his blood work being so wonky he was just more prone to this bacteria invading his system. The good news is, he is on the mend and will be home to me soon. While sitting in the hospital these few days, I just kept telling myself,"Only freak out when and if the medical pros start arriving wearing Hazmat gear and breathing apparatus!" (You know, SARS and Super Bugs). Calmed me down everytime they walked in, in scrubs!!! LOL  Good night Couch

[TnHepGuy_]

I haven't seen the data/studies you have mentioned, but I would speculate that the reason that the non-US citizens had higher SVR rates is that the data is reflecting the larger percentage of harder-to-treat geno 1's in the US - with the number of more-responsive-to-tx geno 2's and 3's that show up in other parts of the world.


TnHepGuy

[snook_man]

Good info!! Hey rev, same one caught my attention.LOL!! I think that EVR has to do with liver damage cause it just is not filtering and eliminating as well, as liver is damaged.
Tnhepguy, quick question for you, I did some research on the stats for peg 2b, and 2a, and 2a does have better SVR for 1a. In the trials though, non-US citizens achieved noticably higher SVR% than US citizens. I was wondering if you have ever seen this comparison, and why that would make any difference. Do you think it is lifestyle or diet? Americans love barbecue, and fast food!!!

[TnHepGuy_]

It looks like with the first paper listed on BILN 2061, that the virus will mutate around it too quickly and there will be high levels of resistance. The good news is that they are already finding the areas of resistance - and can hopefully engineer the next generation of inhibitors to lessen the odds of resistance.

<u>revenire</u> - another thing that jumps out from the Fibrosis study is that in looking at EVR rates, they used a PCR with a lower limit of 100. No telling how many might have been still detectable with a <5 or <10 limit - thus lowering the EVR percentages listed. Also, they used data with both peg and non-peg interferons - and they don't break out and list the results as such. While there certainly seems validity in what they put forth (i.e. - better response rates with lower fibrosis levels) - it does appear that their methods have limitations.



<u>gonagetbetr</u> - hope you are doing well after your shot. I don't know if they apply directly to you, but you may want to look at two of the studies listed above: The one on <u>arrhythmias</u> (since you had mentioned you have a cradiac condition) and, the one on <u>thrombocytopenia</u> (i.e. - severely low platelets).


TnHepGuy

[TravelGrl]

Once again thanks for all the great information..  

Your the best !!
Jodi