for jmjm

hi jmjm, i respect your opinion and wanted to ask you a question, and of course anyone else who has any advice for me would be greatly appreciated. i went for my first visit to a well respected hep doc and after looking at my blood tests & exam he prescribed me peg & "800"mg of copegasys. my last blood tests were all normal except high cholestrol & slightly eleveted glucose. he ordered more blood work, viral load & another liver ultrasound for a marker before starting tx in sept. he said a bx would not be necessary at this time because my vl from 3 weeks ago was 9 million and ultrasound from jan was normal and he wants to treat right away. iam geno 1a and weight 206lbs i was wondering if 800mg riba seems low for my weight. should i asked him to up the riba or can 800mg cure a 1a with 9 mil vl at 200lbs. thanks for the help.

[fishdoc]

...I'm a 1A, weigh 180 lbs.....I started with 1200 riba (6 a day), and have bumped up to 1600.....because of lack of 2 log drop at 12weeks......

[jmjm530]

Genotype 1 is the most common genotype but also the hardest to treat with success rate around 40-50%. It's  also the longest to treat with treatments usually 48 weeks.

Because of this I personally think a biopsy is a good idea prior to treatment to find out how much liver damage you have. As a geno 1, personally I wouldn't treat without one first. Without a biopsy, you're somewhat guessing at because ultrasound isn't a good marker and VL isn't even a marker for liver damage.

There are lots of reason for accurately determining how much liver damage you have including helping you make a decision whether to treat or not. Let's say you have little or no liver damage. As a geno 1, you may still want to treat but a reasonable choice might be to watch and wait, especially with newer drugs like Vertex now in trial.

Regarding the riba, unless you have some sort of special condition, 800 mg/day seems very light for a geno 1 weighing 206 lbs. 1200/day or even 1400/mg day sound more like it.

My suggestion is to consider getting a second opinion from a liver specialist (hepatologist) preferably one who is affliliated with a different hospital from your current doctor so there will be no conflicts.

You probably know that none of us are doctors here are doctors, but personally I wouldn't let any doctor make a decision for me or pressure me into a decision. Take your time, examine your options, including another consultation if you can, and then decide.  

All the best.

-- Jim

[can-do-man]

Hi there, i agree with jim on the bx. im also geno 1, had a ultrasound and then a ctscan before tx. Both showed ok. Had a bx and the fibrosure test and im stage 4. Started at 190 weight base was 1200 on the riba. Then was upped to 1400.

Best to you.

[jmjm530]

Another reason for a biopsy is say you find out your're a stage 3 o 4 and decide to treat. Your treatment strategy might be more agressive given this hypothetical advanced liver damage then if for example your biopsy showed a stage 1 or 2. Lots of reasons for the biopsy. If for some reason biopsy is contraindicated, consider at going to Boston, Miami or some other center that offers the Firbroscan device. Fibroscan is a non-evasive indicator of liver damage now in trial. Not my first choice for a geno 1, but certainly better than Ultrasound.

[goldyn]

Please tell your doc nicley that you have reading up on everything and that you would be comfortable raising the riba,im on 1200 a day, i think for a 1a you should at least have that...

[bobbyullc]

i am 140 lbs on 1000 riba. 800 is real low.

as jim said, get a biopsy to see if you need to tx now or can wait 2 years to see if new and very promising new tx is on the way. if i had normal levels and was only a stage 1 or 2 i might wait and see. i do not know what an ultrasound tells? also viral load vl, is no indicator of damage. just an opinion. if the new vx950 or other drugs work you will still take peg/riba but most likely for a much shorter time. also success is now only 45-50% for 1a and should be much higher with new tx.
bobby

[bobbyullc]

i assume you had a 55 chevy, i had a 55 ford. cooool.
i really wish all would look into hepc to discover what worry is justified and what is imagined.
i feel drs who never did tx gloss over the affects on ones life. ALL info indicates these new drugs will work and drastically change tx. i was told if i do not clear my dr will wait for them.

i really like the idea that drs be made to read this site for 6 months before having the power to rx these drugs. i had stage 3 and did tx and feel it was right but if i had the means to wait 2 years i would not even think about it.
i am also sorry so many take this as a death sentence and ruin their remaning years with fear or feel stigmatized by it. hell,2 of every 100 have it.
bye
bobby

[Bill1954]

Take a look at the following:

http://www.rocheusa.com/products/pegasys/pi.pdf

If you scroll to line 911, you'll see a table showing Pegasys and Copegus dosing recommendations listed by genotype. The prescribing recommendations are clearly stated:

Genotypes 1-4, 180 mcg Pegasys regardless of body weight.

Genotype 1 and 4, Copegus 1000 mg <75 kg (165 lbs), Copegus 1200 mg >75kg (165 lbs).

Genotype 2 and 3, Copegus 800 mg.

As mentioned above, unless you have other underlying health issues known to your doctor, I would seriously question his dosing protocol. If anything, some doctors recently seem to be leaning toward raising the dosage in their hard-to-treat patients. I treated with 1800 mg ribavirin for approximately 10 months, and many others in here are on elevated dosage as well.

Best of luck to you,

Bill

[roaming]

I think 800 is real low. My hubby is a big guy. 300. and he does 1400 which I think (thought) was to low. But he did undetect at 12. Hopefully that will do the trick for him.

[bobbyullc]

http://www.natap.org/2002/NIH/day11.htm

this site explains the reasons to take a bx. and what liver damage is.

[Moniker]

My weight varies from 160lbs to about 170lbs. My doctor had me take 1200mg riba each day for all 48 weeks of my treatment. During treatment, I suffered a skin rash and I had anemia; but I did get undetectable by week 12, and I have been undetectable since. I'm now 6 weeks post tx.

I was genotype 1a. My viral load was 1,900,000 before treatment. The biopsy that I was given before treatment showed I was stage 2, grade 3.

You might want to ask your doctor why he's prescribing only 800mg; he may have a good reason. You might try and find something written on the internet by some big time heptologist which indicates that a higher dose of riba may help clear the virus. If you find a study or written statement about ribavirin dose written by a doctor, you could print it and take it to show your doctor.

[Drarig]

That does seem a little low.  I am F, 1A, (Wk 22/48) weigh 121 lbs and my GI has me on 1,000 mg riba.  I'm not an expert, but after knowing what others on tx post about their doses, I would definitely ask my doc to up that.