Week 6 Blood Work Results

[2mlbb]

Starting week 7 today with 7th shot tonite. Am pondering the numbers that i received. Am grateful for some of them but on alert for a few others. I am doing all that I can on my end but, they are what they are.

LEUKOCYTE COUNT   3.2
RBC      3.7
HEMOGLOBIN  10.7
HEMATOCRIT    33
MCV       88
MCH       29
MCHC     33
RDW       13.4
PLATELET COUNT   186
NEUTROPHILS, ABSOLUTE     1.85
LYMPHOCYTES, ABSOLUTE    .87
MONOCYTES, ABSOLUTE         .4
EOSINOPHILS, ABSOLUT          .02

Have appointment with hep c doc on the 22nd....

[2mlbb]

Good morning. Thank you for our encouragement Stormy. They are checking every 2 weeks at this point...Will ask about upping it at my May 22nd appointment. Thanks again.

[stormy456]

You're lookin' good.  Seven weeks in with these numbers?  Great news.  Hope your doctor is checking your CBC weekly anyway.

[BoceprevirGal]

Yeah,(@hrsepwrguy) but also you started out with a really high HGB, if my memory serves me right, so you have had a big drop. I started out kind of low (12.9), not sure if starting point of HGB has anything to do with wether hemolytic anemia will hit faster, though
    

[2mlbb]

Thank you so much for your posts. That is quite a bit of info to process but will do my best to understand. Thank you for the encouragement on my blood numbers. Very kind of you indeed.

[hrsepwrguy]

I should add that this type of testing is not commercially available but my point is that you don't have to be anemic to be absorbing the riba in proper concentrations however it doesn't mean that you wont become anemic either

And as Will said your bloods look great and good luck going forward

[hrsepwrguy]

Adequate Ribavirin exposure after the first dose predicts SVR in genotype 1 patients
Last updated:08July2008

7th July 2008 By Liz Highleyman hivandhepatitis.com

Studies continue to show that adequate doses of ribavirin, which helps to prevent relapse after completion of therapy, are important for optimal treatment of chronic hepatitis C virus (HCV) infection.

Hepatitis C is a virus-caused liver inflammation which may cause jaundice, fever and cirrhosis. Persons who are most at risk for contracting and spreading hepatitis C are those who share needles for injecting drugs and health care workers or emergency workers who may be exposed to contaminated blood.

But actual ribavirin concentrations achieved in the body after dosing may be more relevant than the amount administered, according to a French study published in the May 2008 issue of Hepatology.

As background, the authors noted that previous studies showed "marked inter-individual variability" of ribavirin concentrations despite dose adjustment based on body weight. Furthermore, data suggested that there was a correlation between single time point ribavirin concentrations and achievement of sustained virological response (SVR), or continued undetectable HCV viral load 24 weeks after completion of treatment. None of these studies, however, evaluated global exposure to ribavirin.

In the present study, the investigators conducted an exploratory pharmacokinetic-pharmacodynamic analysis of 28 genotype 1 chronic hepatitis C patients treated with pegylated interferon alfa-2a (Pegasys) plus weight-based ribavirin for 12 weeks, with amantadine (an influenza drug once studied as an experimental anti-HCV therapy) added for an additional 36 weeks; 24 participants completed the study.

Full and abbreviated ribavirin area under the concentration time curve from 0 to 4 and 0 to 12 hours (AUC(0-4h), AUC(0-12h)) were derived from plasma concentration profiles at day 0, week 12, week 12 + 1 day, and week 24. Virological response was assessed at day 0 (0, 12, and 24 hours), at weeks 2, 4, and 6, and then monthly through week 72, using a TaqMan polymerase chain reaction assay with an HCV viral load threshold of 15 IU/mL.

Results

• Patients who achieved SVR had a significantly higher ribavirin concentrations at day 0:
- AUC(0-4h): 2010 vs 1340 microg/hour/L (P = 0.03).
- AUC(0-12h): 3695 vs 2937 microg/hour/L (P = 0.03);



• Patients with day 0 AUCs above the cut-off values defined by receiver operating characteristic curves (1755 microg/hour/L for AUC(0-4h) and 3014 microg/hour/L for AUC(0-12h)) had a significantly better chance of achieving SVR than participants with AUCs under these thresholds (odds ratio 16.0 and 8.9, respectively; both P = 0.02).

"Ribavirin exposure at [day 0] is significantly related to SVR," the study authors concluded. "We propose a minimum AUC(0-4h) threshold of 1755 microg/hour/L at [day 0] as a target for ribavirin dose adjustment."

"To our knowledge, this is the first study to give an early pharmacokinetic predictor of SVR," they added.

If these findings are confirmed, early ribavirin concentration may be added to the several other factors (including HCV genotype, pre-treatment viral load, and rapid virological response) that can be used to predict - and ideally improve -- the chances of sustained response to hepatitis C treatment.

Reference
V Loustaud-Ratti, S Alain, A Rousseau, and others. Ribavirin exposure after the first dose is predictive of sustained virological response in chronic hepatitis C. Hepatology 47(5):1453-1461. May 2008. Abstract

This study is a little older and was just SOC, I am in a current concentration controlled ribavirin study in which the targeted levels are higher than stated in this study and include incivek

http://clinicaltrials.gov/ct2/show/NCT01097395?term=hepatitis+c+AND+colorado&rank=1

Primary Outcome Measures:
•ribavirin AUC-12 variability [ Time Frame: steady state (~weeks 9-10) ] [ Designated as safety issue: No ]
Demonstrate that concentration-controlled ribavirin dosing can achieve a targeted level of plasma exposure with reduced variability in the steady-state area-under-the-concentration-time curve (AUC0-12) compared with standard weight-based ribavirin dosing

Secondary Outcome Measures:
•safety - absolute hemoglobin declines [ Time Frame: end of treatment ] [ Designated as safety issue: Yes ]

In the ribavirin concentration controlled arm those with an AUC0-12h > 7000 or < 3000 ng*hr/mL will have their doses adjusted to a target AUC0-12h of approximately 5000 ng*hr/mL

I am in the concentration controlled arm so I am targeted to the 5000 ng*hr/ml, I have not been anemic, I did have 1 cbc that showed an 8.9 but after retesting 3 times in the next 14 days it was determined that it was a lab error and my HGB has never been lower than an 11

[2mlbb]

Thank you. I trust your information and appreciate your feedback. So much to learn. Just happy that I set aside this time for treatment. I had no idea all of you would go with me. Thanks for your patience and support.

[willbb]

Sorry 2mlbb on the sidetrack  .
Your bloods look great and good luck going forward.
Will

[willbb]

clearing

[willbb]

That article is outdated and pertains to when treatment was doing just  SOC(PEG/RIBA)
. The concentration of Riba was extremely important (and still is to a certain extent) and the only way to keep score ,per se was to gauge HGB,,
,however with advent of the triple therapy ..again no doctor would keep increasing Riba until one fell into anemia for the purpose of cleaning virus.

Will

[BoceprevirGal]

Oh, here's the link to that last article I mentioned.
   http://www.gastrojournal.org/article/S0016-5085(10)01222-9/abstract

  But the person whose Doctor had his ribavirin upped was also a very tall, heavy guy, so it has to do with getting the Riba dosage correct, for body size maybe.

[willbb]

upped his Ribavirin , until it gave him (hemolytic) anemic, because he wasn't able to clear the virus, until the Riba knocked his HGB down....I will try to find an article on it for you
------------------------------------------------------------

No knowledgeable doctor in the course of triple therapy would ever increase one's Riba until the patient fell into "hemolytic anemia" for the sole purpose of "clearing the virus"

Any doctor prescribing like that has no business anywhere near an HCV patient..
Will

[BoceprevirGal]

Here's an article, from a GastroJournal ~
  Background & Aims
Hepatitis C virus (HCV) treatment is frequently complicated by anemia from ribavirin (RBV)-related hemolysis and peginterferon-alfa (PEG-IFN)-related bone marrow suppression. We investigated the relationships among treatment outcomes, anemia, and their management with RBV dose reduction and/or erythropoiesis-stimulating agents (ESAs).

Methods
We analyzed data from a trial conducted at 118 United States academic and community centers in treatment-naïve patients with HCV genotype 1. Patients were treated for as many as 48 weeks with 1 of 3 PEG-IFN/RBV regimens. ESAs were permitted for anemic patients (hemoglobin [Hb] 3 g/dL, 43.7%; ≤3 g/dL, 29.9% (P < .001). Anemia occurred in 865 patients (28.6%); 449 of these (51.9%) used ESAs. In patients with early-onset anemia (≤ 8 weeks of treatment), ESAs were associated with higher SVR rate (45.0% vs 25.9%; P < .001) and reduced discontinuation of treatment because of adverse events (12.6% vs 30.1%, P < .001). ESAs did not affect SVR or discontinuation rates among patients with late-stage anemia.

  

Conclusions
Among HCV genotype 1-infected patients treated with PEG-IFN/RBV, anemia was associated with higher rates of SVR. The effect of ESAs varied by time to anemia; patients with early-onset anemia had higher rates of SVR with ESA use, whereas no effect was observed in those with late-onset anemia. Prospective trials are needed to assess the role of ESAs in HCV treatment.

[BoceprevirGal]

Yeah, lots of times, people who have a hard time clearing this virus, will also notice that their HGB isn't going down, also. One poster on here told me his Doctor upped his Ribavirin , until it gave him (hemolytic) anemic, because he wasn't able to clear the virus, until the Riba knocked his HGB down....I will try to find an article on it for you
  

[2mlbb]

Thank you so much for your post...Now I hadn't looked at it that way...hmmmm

[BoceprevirGal]

If it makes you feel any better, early-onset anemia is a good sign that your body is getting enough medicine to remain SVR, after treatment.

[2mlbb]

Thank you. Hard to watch them drop as I'm sure everyone knows this. Two weeks ago that 10.7 was 11.9   Hangin in there...

[can-do-man]

Your numbers look great for somebody on treatment, couldn't ask for anything any better at week 7. Keep an eye on your HGB but at 10.7 your still good........... Best to you.