Weight based riba; is there still time?

[meNtoby]

I'm really worried now, and need advice about my treatment.  Please help!  After reading Marcia's post and the importance of the 4 week VL for geno's 2 and 3, I think I am not taking enough Riba either!

My stats are different though, so that is why I'm starting a new thread for clarification. I am geno 2b. My Hep and his NP (whom I see now) seem to have a cookie cutter approach to all geno 2's, and said they would give me 180 mcg Peg, and 800 mg Riba, and if I cleared at 4 weeks, would treat for just 16 weeks total.

I've been against that time length when it's come up, but figured I'd cross that bridge later.  When I mentioned I wanted the Riba to be weight-based, she said with my weight (at that time 165#) was "on the line" so she would go to 1000 per day if I wanted. My question on that is, was I on the line between 800 and 1000, or between 1000 and 1200?

I'm truly worried now, because I'm 2 weeks into treatment (shot 3 will be Friday) and I just found out my starting VL was not 17 million, but 30.3 million.  I've been taking 3 pills in the morning, and 2 at night.  After reading Marcia's post, and the concern about her not quite clearing at 4 weeks, I am a bit freaked out now about my chances.  And am wondering if I'm taking enough Ribavirin too.  

I thought all this time that I was taking the higher end of the weight based Riba, but not so sure now.  Could someone help me out with this?  I think I should immediately up my dose, and worry about telling the NP when I go in next week.  I've been really optimistic up until now about my chances of clearing, but this new VL number came up and smacked me in my Pollyanna head.  Right this minute I weigh 158 pounds.  I wasn't real worried about that either, since my bmi was still in range at 5'10" tall.  Now however, I am thinking it will be a miracle if I clear at 4 weeks, unless I up the Riba and give myself better odds.

Any advice here would be appreciated.  Do any of you guys know any stats on a VL that high?  Good ones anyway?  The bloodwork that I HAD seen before starting, showed my ALT and AST's were much lower (67 and 39, respectively, down from 103 and 71 in May) so I started out very enthusiastic.  

Getting anxious now.
cathy

[Kristina538]

Another post about G2's with some relevant info:

http://www.medhelp.org/posts/show/562099

[Kristina538]

Something on the 16 -v- 24 weeks  (I know there is another study and if I find it I'll post it; this one is from 2007 and mentions the VL and that 16 weeks is okay for a particular subset of patients).  

http://www.hivandhepatitis.com/hep_c/news/2007/072007_b.html

I'm sure there is a more recent study though.......

This one says a bit about the riba but is a little non-specific...

http://www.hepatitis-central.com/mt/archives/2008/04/factors_improvi.html?eml=hepcen52

I was put on a higher riba dose because I relapsed in 1994 and because my liver has high fibrosis.... I wonder if the bx stage has to do with the higher riba.  I really struggle with it (more to do with nasty bowels and smells, riba cough and a blocked nose,  as I don't seem to be anemic yet - but notice drops - maybe I'm part of the 15% that Trish mentioned that benefits from B12/B6?).

My private specialist said he would've put me on 800 and was concerned that I was on 1000 (and checked my creatinine levels to make sure I could handle it (?)...  My treating specialist said 'it was a matter of opinion' currently regarding the riba dosage.   I'm a 3a relapser so I guess the stats say to hit me hard (53 kg); I achieved RVR <15IU.

MeNToby - I can't comment really and there are too many variables to assist you and I'm no doctor, but I'm glad you're a G2.  I met a lady who was on the same riba as me (1000) is a g2, was much heavier and had much less liver damage than me and has cleared.   Of course, that's only one person so good luck with your research....

[comeagain]

About crossing that bridge later 16 weeks of treatment.
I think 16 weeks are out of the question for you with that high baseline vl.

I have seen a studie that says the only ones who could consider shortening treatment to 16weeks (almust sure that was for geno 2s aswell )was people who had very low baseline vl.

Maybe Marcia or cocksparrow has the link to that study.

ca

[meNtoby]

I'm okay, it was the realization about the 4th week VL importance that spooked me... And the 12th for that matter... And finding out my baseline VL was so high....

I'm considering the higher dose riba-- or I could gleefully put back on ten pounds!  There are a couple of other issues I'm waiting to see about on the bloodwork results that were mis-mailed, so I'm good now that I've tracked those down too.      

Glad to see you are off that wall hitting...lol  I know that you will come up with a plan and conquer the beast!   I'm just skating along over here, I take my riba with ice cream and cookies. Take a vitamin C for good measure. Nah, I do a little better than that really. :-))

Take care,
cathy

[Marcia2202]

Cathy, wow... sweetie.... I'm so sorry that my commotion caused you so much distress....

First, it's exactly what every one says... You are a geno 2.... you shouldn't worry about my problems at all... :-)

And if you are 158 lbs, that means 71.7 kg, and on 1000mg Riba that would be 13.9 mg/kg... you should be okay as a geno 2, I would say. But if you are really concerned and can handle a bit more riba... maybe it wouldn't be a bad idea... but I don't know how to approach geno 2...

And you are having a 4 week PCR so that's a good thing.

So it seems you have all your ducks line up the right way.

I will be humming with you unnnnnnd unnnnnnnndddddddd etc....

Am rooting for you!

Marcia

[meNtoby]

LOL, I'm still cracking up over the poke poke poking on your liver!  Thanks once again for the chuckles and yuks!  When I take my riba, I picture the old Pac Man game, and the drugs are eating up all the mean little virions.  Really, 30 million total would be high enough, but 30.3 million per, is omg, it's an invasion!  Die you rat bas*****!

Thanks for the pep talk, I'm all better now. I'm a 2. We're cool. :-)

I'm a 2.

[nygirl7]

Don't worry too much about your starting viral load.........you are lucky.......it means you have more of those nasty suckers to enjoy killing off :)

On a serious note I started with a very LOW VL...and did not clear until somewhere between week 12 - 24.  and I took almost DOUBLE the riba daily (because I was crazy).

I would up my dosage if I could if I was you...but remember, with a higher dose comes the chance of more severe anemia - so you really do need to take into effect all of the aspects that you can.

Make sure you get a 4 week test......... you will still have time to up things if you need to but I bet you get those nasty suckers and kill them off just fine!

Your a 2 and there is a pretty big difference between a 2 and a 3 believe it or not so try not to sweat it out. If anything your odds are great from the get go.

[meNtoby]

Okay, well I found out my 1st weeks blood results (last thurs) were electronically sent to the wrong doctor, wrong city, and they mailed them to my doc, who now has to mail them to me, rather than post on their website portal. Tomorrow's bloods should be posted Friday, so I can see where I'm at on 2 week's values.  

I feel just fine though, so I don't think hemoglobin is tanking.. I am due now to see NP anyway after this 2nd draw, so I may ask her about upping the Riba since I am so close to the weight border. I won't get a VL until 4 weeks, then 8 weeks if we stick to schedule. I read somewhere that the VL takes the biggest hit in the first 24 hours of treatment. But I figure while I'm still in that first 4 week frame I want the heaviest smackdown I can give it.

Cowriter, yeah I was comparing her results because her VL was so much lower to begin with, and she has probably supplemented and in general, even eaten better than I have been, no doubt.  It's hard not to panic!  Like if Marcia didn't get there, how can I possibly have a shot!  Thank you for your input, I understand we're different genos, but I had her on a pedestal.  lol

I will remain calm and think uunnnnndddd, unnnnddddd, unnnnnnd.  I had some bad sides 8 hours after that first shot, but since then, nothing to complain about. Best of luck to newbies out there, and thanks to all you veterans for all your assistance!  I'll let you know how that 4 week milestone turns out...the 30 million dollar question.

Blessings all,
cathy

[jmjm530]

The other point is that her doc is considering the 16 week shorter course and if memory serves me, those studies all favored weight-based. That said, more and more doctors appear to be starting geno 2's and 3's off on weight-based at least from what I've read here.

[jmjm530]

CO: On a female, genotype 2, 158lbs?
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We're working with 165 pounds as I understand it :) and therefore 1200 mg/day would still be considered weight-based, correct? But again, I really see her hgb curve and symptology overriding at this point. If all is OK, I only see an upside to increasing the riba based on overall study data although I"m sure there are no studies to match up with this case exactly.

[CoWriter]

"More important, however, IMO is how she is handling the current dose, i.e. symptons and hgb levels. If all is fine, then I personally would up the dose"

On a female, genotype 2, 158lbs?

There's no data that says a geno 2 will do better on 1200mg.  

[jmjm530]

When I mentioned I wanted the Riba to be weight-based, she said with my weight (at that time 165#) was "on the line" so she would go to 1000 per day if I wanted.

CO: She's already on weight based dose.
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CO -- you bring up an interesting point, but please note that she appeared to be at 165lb at the time she started treating. We've had discussion on this issue -- where you apply the weight base (pre-tx or real time) but the reality is that most of us get our riba calculated pre-treatment and I my hunch is that is how all the trial data works too. Sooo...in that respect, she could go up to 1200 if on the cusp, based on a weight-based scheme using pre-tx as baseline. More important, however, IMO is how she is handling the current dose, i.e. symptons and hgb levels. If all is fine, then I personally would up the dose because the best info I've read suggests weight-based is somewhat of a crude barometer anyway compared to serum riba levels.

-- Jim

[CoWriter]

You can't compare yourself to Marcia.  She has genotype 3 and you have Genotype 2.  Hers is more difficult to clear than yours.

For you the recommended dose is 800mg and instead you're taking weight based dose....which is more than the usual for Geno 2.

"My question on that is, was I on the line between 800 and 1000, or between 1000 and 1200? "

You were on the line between 1000 and 1200mg.

If over 165 lbs, the dose is 1200mg.

At this point your weight is 158 lbs and 1000mg is the right dose for "weight-based".  That should be enough.  

[CoWriter]

"If your nurse gave you the option for weight based, then personally I'd call her and switch to weight based now"


She's already on weight based dose.  She said....

"I've been taking 3 pills in the morning, and 2 at night."

And she weighs 158 lbs.  

[Trinity4]

Again, the genotype differentiation keeps popping up.  Newer studies show weight based riba for 2's & 3's may promote RVR as opposed to fixed dosed of 800 mg.

PEGASYS and COPEGUS Dosing Recommendations


Genotype PEGASYS Dose COPEGUS Dose Duration
Genotypes 1, 4 180 µg <75 kg (165 lbs.) = 1000 mg 48 weeks
≥ 75 kg (165 lbs) = 1200 mg 48 weeks
Genotypes 2, 3 180 µg 800 mg 24 weeks

[jmjm530]

If your nurse gave you the option for weight based, then personally I'd call her and switch to weight based now, assuming you're handling the side effects relatively OK and your hemoglobin isn't tanking too bad. As to "borderline", I believe 165 is borderline between 1000 and 1200 mg/day on one weight based scheme, but I'll let other confirm as it's been awhile.

-- Jim