Adjuncts to IFN monotherapy??

[mindlesley]

I am starting IFN (pegylated alpha 2a) next week. Because I am on home hemodialysis for ESRD caused by diabetes - now well controlled, I can't use Riba and I am interested if there is any efficacy studies on supplementing with l glutathione, naringenin, Nac or one of the plethora of substances I've read about in Professional Journals on the net. Worried about the drug interractions/?kidney clearance of naringenin. Phosphatidyl choline?? I  have 3a genotype and a rising viral load about 3.5 million. It seems a lottery whether or not I'll respond. I have moderate, not bridging yet, fibrosis and until I started hemodialysis had no raised LFT's and very low viral load. But have had the infection since 1968 (It was a very wild year). Used myself as a guinea pig during my 3 years in Medical School. I had frank jaundice twice in that year, so imagine i copped Hep C and became immune to Hep B then, as I cleaned up my act not long after and have had no risk factors since. Alt  and Ast now elevated to 60-65 but I understand I may be returning lower levels than what i actually have because of high flux dialysis. Ironically enough until 3 years ago I worked mainly with IV drug users that had blood borne disease problems. Hope you can help, Mindy xxx

[mindlesley]

Thanx for useful comments. Orleans, love dat town, I will do some research on Alinia. Fretboard, I play keyboard (s), appreciated your thoroughness. Maybe i forgot to mention I only had inflammation 5 yrs ago and now have fibrosis. I think hemodialysis and its suppression of immune function is making the HCV disease progress. Ribavirin leads to severe hemolysis in people with a creatinine clearance of less than 20; mine is about 7. Although there have been no proper scientific trials yet because they are scared to enroll people in the riba arm; thinking it might be a bit unethical to risk their lives in the name of scientific inquiry. Also I am on transplant list and there is a real worry that 1. the new kidney could be buggered up by the HCV if Idon't treat and 2. treatment after transplant is not encouraged because Interferon is an immune stimulant which might cause acute rejection of the grafted kidney. So there lies the dillemmas! If it was an easy call I wouldn't be so worried  (being a bohemian chick and an existentialist I usually don't worry! or maybe like Alfred E. Neumann - "What?, me worry!) Any further suggestions or references from you or any other kind person would be gratefully accepted. Regards Mindy xxx

[fretboard]

Maybe you should go to pubmed and read a little bit about txing while being on dialysis.  Those meds go thru every organ you can think of including your kidneys.  I can't think of any current tx that excludes the use of Ribavirin.  Maybe you can get into a trial, whatever you decide I hope your doctor knows what he's doing.  Also just to use the IFN doesn't work, here’s a link that is current.  One last thing is I didn’t read that you’ve had a biopsy and what I did read says that your liver has minimal damage.  Your VL is not that high at all and could be in part for other reasons, like some meds you are on.  You have time to wait to treat, you really don't want to tx at the drop of a hat and end up with a lower quality of life.  Good luck and God Bless

http://www.sciencedaily.com/releases/2008/12/081204133645.htm

Hepatitis C Infection and Chronic Renal Diseases.
Perico N, Cattaneo D, Bikbov B, Remuzzi G.

More than 170 million people worldwide are chronically infected with the hepatitis C virus (HCV), which is responsible for over 1 million deaths resulting from cirrhosis and liver cancers. Extrahepatic manifestations are also relevant and include mixed cryoglobulinemia, lymphoproliferative disorders, and kidney disease. HCV infection is both a cause and a complication of chronic kidney disease, occurring largely in the context of mixed cryoglobulinemia. This infection also represents a major medical and epidemiologic challenge in patients with end-stage renal disease on renal replacement therapy with dialysis or transplantation. In these settings the presence of HCV correlates with higher rates of patient mortality than in HCV-negative subjects on dialysis or undergoing kidney transplant. The major concern is the lack of safe and effective drugs to treat HCV-infected patients with chronic kidney disease. Unfortunately, there are no large-scale clinical trials in this population, especially those receiving renal replacement therapy, so that strong evidence for treatment recommendations is scant. This review article provides the readers with the most recent insights on HCV infection both as cause and complication of chronic kidney disease, discusses pitfalls and limitations of current therapies, and reports on preliminary experience with novel therapeutic agents, as well as directions for future research.
PMID: 19129320 [PubMed - as supplied by publisher]

[orleans]

ALINIA!!! Notice the 44 paitent arm with Inf/Alinia only. 80% svr. A small study granted,but still. My Dr prescribed it to me off label, BSBC covered it, I was UND at 2 weeks G1 (I did use riba) Sx nearly non-existant, just a little gastro stuff. Also PPC, ask "gauf" about this and other supps . jerry