continued

[Proactive]

Having trouble posting, can you not comment on your own post?
Sorry for the second thread
continued....
As to the various vl tests out there, unfortunately these are our only guide, but as mentioned above, I've had 2 different tests done from the same samples on the same day with a large difference of results on a percentage basis. 1200iu compared to 2000iu, only 800iu difference but a huge percentage difference between the 2. Imo, the accuracies of these tests is questionable at best, one has to wonder how many relapsers were never undectable to begin with.
I also would caution putting to much faith in some of the study data released, obscure tiny studies simply care no weight with me,again the riba/fat syndrone..
Biggest sx for me, tired all the time, no stamina at all. Peg doesn't seem to bother me much, but sure feel the 1600 mg riba per day on my 170# body!! No weight loss, slight hair loss, was bald anyway!

Later, and again thanks to all
Do your own research!!!!!!!!!!
Proactive

[nygirl7]

These are not small studies that are out there. They have been thoroughly backed up by the greatest minds of the hepC community in our time.

The "expert" doctors know much more than we can ever begin to understand. While we do our own research to try and improve our odds - I would never go against the advice of a Dr. J for example. To presume I know more about hep than my GI is one thing but a doctor like that? Uh no.

If you have the most sensitive test available to determine your status of UND - chances are it is pretty accurate. HOwever if you have one of the older tests (315? 615?) you really have no idea whatsoever.

[jmjm530]

Proactive: everything has to be taken with a grain of salt. (example: taking riba with fat often touted here.Have yet to verify anywhere,yet pushed as written in stone
---------------------
Well, you certainly know how to make an entrance :)

Regarding the above, have you checked the package insert for ribavirin?

Under the "Clinical Pharmacology":

Effect of Food on Absorption of Ribavirin:

"...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)..."

Package insert here:
http://www.rocheusa.com/products/copegus/pi.pdf

---------------------------------

As to your comments on differing lab results on the same day (1200iu compared to 2000iu), it's not a significant difference. In fact, one can expect up to a one-log difference due to testing variances alone. In other words, if the 2000 IU/ml turned out to be > 120,000 IU/ml, then you'd have a significant difference.
Source: Dr. Mitchel Shiffman teaching module, Clincial Care Options
http://www.clinicaloptions.com/Hepatitis.aspx
IMO this is one reason that anything less than a one log drop is insignficant. In fact, it may mean theat the viral load isn't changing at all.
--------------

Lastly, you may or not be aware that 72 weeks (not the 53 weeks your doc is suggesting) is becoming the standard tx length for those that are detectible at week 12 but non-detectible at week 24. This btw is not an obscure study although like you suggest, everyone is different, has different stats and therefore should not be treated cookie cutter.

All the best luck with treatment.

-- Jim

[Kalio1]

I couldn't agree with you more regarding using studies to plot your course. I think it's a good idea to examine them and apply ideas and theories to your treatment and your individual situation, but the blanket nature of some things put forth here are troubling, like the fat with riba you mention. I have seen one small paper saying fat increases absorbtion however I have not had any doctor suggest this was necessary or important nor have I seen any SVR data showing that it actually works better than just taking it without fat. In fact, consuming a bunch of fat is bad for your liver, so I wonder if that advice isn't causing people more harm than good, we know that being at your ideal weight and eating a "liver friendly" diet are health positives, it seems that if you consume big fat ladened meals on tx twice a day with your meds you could be working at cross purposes.

I wish you all the best on your tx, I try to keep in mind on this long weary treatment that there is not just one singular goal of tx even though it seems as if the only goal is to SVR, the benefits of suppressing the virus in spite of SVR are well established. Keeping a lid on it does allow our livers and bodies to heal even if we can't rid ourselves of it completely.

You have my sympathies on the farigue issue. I know how that is, it just lays over your whole life and colors everything.
I have seen real benefits to using a regimen of immune support/nutritional supplements and have been able to ameliorate the fatigue somewhat, even on tx. I swear by the stuff because I could see and feel a real change occur about a month after I started my daily regimen. Maybe they could help you?

[jmjm530]

Maybe our post crossed, or maybe you just haven't read my above post. But in any event, the fat absorption thing is not just a "small paper". It's actually listed on the ribavirin package insert, not to mention that a lot of our liver specialists have told us to take ribavirin with meals that have some fat in them.

[Kalio1]

There isn't any data that shows that is true, I have read the insert but not seen anything showing people who ate high fat meals with riba SVR'ed more, have you? Drug inserts cover everything but meteor strikes, that isn't a very good reference to the use of fat with riba to me nor does it offer any science to legitimize it. It gives people the idea that a fat ladened meal twice a day is "good" but that is very hard on your liver and is not good for you at all, that too should be factored in the risk ratio particularly in light of the lack of evidence it will improve SVR. There is a lot of evidence showing fat ladened meals stress your liver and can even increase the likelyhood of fatty liver.
Taking in two high fat meals a day has it's own risks and without any evidence showing it will improve my chances or any recommendation as to HOW MUCH fat is needed, doesn't seem like a good idea. Taking it with a small amount of "good" fats ok, but eating huge egg/baccon/homefry type meals is not helping in my view.

  

[jmjm530]

I doubt the drug manufacture would cite a study they didn't believe be true. No SVR studies testing the variable of fat content in meals that I know of -- but a number of studies suggesting both the importance of ribavirin and ribavirin serum levels and how they affect SVR. Therefore if a high fat meal makes more riba bioavialable and more available riba which we know means a higher serum riba levels and higher serum levels mean a better chance of SVR...well, that's how I do the math, you can do your own, as can everyone else.

That said, I've never once suggested anyone eat the breakfast you describe, or even suggest anyone eat a high fat meal. What I have done is suggested that people take ribavirin with food that has at least a moderate fat content based on the above, and leave it up to them as to how much more fat they may or may not want to add.

In my case, I did eat the breakfast you describe, but since you obviously have read my posts, you also must have read that one of the other reasons I ate such a high fat meal was because, like many, I had an anorexic reaction to the treatment drugs and lost close to 30 pounds very quickly.

It was therefore either I put on the calories with any foods I could tolerate -- and there were only a few -- or go on testosterrne therapy or maybe anabolic steroids as my doc suggested -- or discontinue treatment. I choose bacon and eggs over anabolic steroids.

Now that I've clarified my position -- again -- I would appreciate in the future that you no longer mischaracterize what I've said about how much fat people should take with their ribavirin or reference my breakfast without mentioning that I was also desperate to maintain weight.

[nygirl7]

God...I wish I could eat a breakfast like I could during treatment (well I really couldn't eat much then) now POST treatment!!!!!

Even just eating water I seem to be gainning weight LOL what I wouldn't give for bacon, sausage, cheese omelettes and homefries!  ;)


My doc did explain when I finally asked him (not that he told me of COURSE) that the riba binds to the fat molecules so you retain more of it.  Of course he never told me to take it with a moderate amount of fat...which IS sensible.  I tried to use natural fat proteins like peanut butter and yogurt. I'm even wishing for eating THAT stuff again now and I hated it towards the end.

Hey you all know I'm lying.............I took my riba with ice ceam and nothing but ice cream ;)

[jmjm530]

Is your fat going on mostly on the abdomen, or more evenly distributed? Just be careful because you're just off the drugs and in my case just about all the weight gain was fat. Also, have you checked your cholesterol and triglicerides post treatment and compared them to pre treatment. A thread going on about this over at Janis.

-- Jim

[FlGuy]

Since your doc was aggressive in raising the riba dose, I wonder why he was not so aggressive with the pegintron.  He could have adjusted to the 150/.5 as the riba increased for an added tx kick.  At 120/.5 that's for a max weight of 187 (you were 170).  Seems like he was taking a greater risk with the riba, and not so much the peg, weight-proportionally speaking.