I reached <43 at my twelve week test, and my 8 week test was 403 so i really feel it was shortly after my 8 week test. I currently take 0.4 ml of 120 mcg of PegIntron and 1000 mg of riba. He wants to reduce my pegintron to 0.35 ml and riba to 800 mg. The riba due to weight loss of 20 pounds and my hgb was 9.5. I am a genotype 3a, starting VL 75,000, only down to 25,000 and week 4, then 403 at week 8 and negative at twelve. I have 6 more weeks of treatment and also my AST and ALT has always been running high. Any thoughts??? I am going to ask on Tuesday appt. to extend my treatment to 24 weeks past my <43, not just the standard 24 weeks for 3a.
If the issue is only the white blood cells then reducing Riba will not help. They usually reduce the interferon to help recover white blood cells. I would be more concerned with reducing interferon then ribavirin at this point.
Agree totally with banarep. At this point a riba dose reduction is not going to hurt you. The riba serum level in your blood should be very good by now. I know ribivirin contributes to low ANC but the main culprit is the interferon and when docs start talking dose reduction of interferon I get a little skittish. You've got six week and if you start Neupogen today you would probably see your ANC rise by Thursday or Friday. It's very fast acting for most. An ANC of 530 is low but not critical, however, doctors have their comfort zones and mine freaked out when I hit around 600 I think so I can understand why he wants to reduce the interferon but I don't get the ribavirin reduction. Keep in mind, ANC goes up and down so it may rebound by next week.
I'm speaking for myself here but my doc told me to reduce twice and I didn't do it because I felt it wasn't merited.
Good Luck
Trinity
Hi there,
When did you reach undetected?
Although I suffered from an obsession to never dose-reduce during my treatment, several people here dose-reduced and succeeded.
How much does your doc want you to reduce and what is your current hemoglobin level?
I would say that at this point in your treatment, riba dose reduction should not be a problem. how much are they reducing it?
here is a link: http://www.hcvadvocate.org/news/newsRev/2007/HJR-4.3.html#1
as long as you receive 60% of the riba you should be okay.
Riba reduction shouldn’t affect white cells; are you anemic as well? Neutrofils at 530 aren’t dangerous, but he’s probably trying to look forward and prevent trouble down the road.
It might be pointless to intervene with Neupogen right now; has this been discussed? Neupogen can increase neutrofils without IFN dose reduction; but I’m unsure how critical full dose IFN is at this late juncture of therapy.
Others better informed in this will hopefully respond. Good luck,
Bill
Yeah, it's issues like this that come to my immediate attention so to speak. Why is the dose reduction occuring? You may also stand the chance of relapse occuring with a Riba reduction.