jm jm

Hi Jim, I wanted to ask you a question about hemaglobin, i noticed in a couple of past post that you mentioned people have a better chance of SVR if they become anemic, is this true? I never did become anemic my hemo was 140 pre tx and today it is 117 (Canadian numbers). Anything below 120 is considered low but i think the lowest i have gone to was 115. I was Und at week 4 and geno 2 did short course 16 weeks, but only finished 15 weeks.
I had more problems with my ANC and had to use nueprogen. I did have a PCR test at the clinic today, but i have not even been finished tx for a week yet, then i don't get another one for 6 months. I guess i just get a little freaked sometimes, so are my chances for SVR lower because i did not become anemic? Or is it a good sign if your hemo just makes some kind of drop?  Thanks Anita

[jmjm530]

Ana: Or is it a good sign if your hemo just makes some kind of drop?
-----------------------------
Yes, I would think the drop to be the important thing, and you did have a two-point drop. But more than that, you were non-detectible at week 4 which more or less trumps everything else. Also, you're a genotype 2 where higher doses of ribavirin appears to be less important than with geno 1's. In other words, not to worry about the anemia/SVR thing. You have every reason to be optimistic about SVR.

All the best,

-- Jim

[snowbyrd]

Thank you for the info. I knew that things are different with geno 1 and 2 but i just got a little freaked. Thanks again for putting my mind at ease.  Anita

[ladybug52]

Please read 52tele post on the forum. He was not und early on like you and even tho he had a significant hgb drop, it wasn't an indicator of success like your und. Plus geno 2's respond to tx better.
I hope.
Worrying myself!
Bug

[nygirl7]

I believe it's an assumption that is made that people assume if you are absorping full amounts of riba they develop anemia and therefore know "it's working".

I've never seen any study to support this fact in the two years I've been on this board.

I had one of the worst cases of anemia I've read on here and had to do 72 weeks because even though I had quite a significant drop at 4 weeks - I had a 400 number until somwhere after 12 and before 24.

I dropped six full points in just over a week (from 15+ to 9) which is about the worst thing that can happen (it's not only the hemo number going down but how FAST it goes down) and well........as you can tell it didn't correlate into any sort of success.

That happened at week 3 or so.

Debby

[desrt]

Please reference studies or any other proof that links anemia with SVR.

[jmjm530]

It's not just an "assumption" and several studies have been posted here by myself and others to support this thesis. Unfortunatly, can't find them now, but you might want to check either http://www.hivandhepatitis.com/ or http://www.natap.org/ where I believe the studies came from. I believe -- not sure here -- that FlGuy also posted a study on this so I flagged him as well. The studies do not say you have to be anemic to achieve SVR but do suggest that RVR and SVR is positively associated with Anemia. There is also some earlier work by the Sweedish reseacher, Lindahl, that also supports this thesis. You also might try our archives -- good luck on that :) -- and search under "Fishdoc, anemia," or something like that. Fishdoc, as well as some others, were told that based on their lack of hemoglobin drop they weren't absorbing enough ribavirin and therefore needed more. In fact, it might just be easier to post to "Fishdoc" to get the story.

-- Jim

[desrt]

I read Lindahl when I first came on this site 6 mo. ago. Unless I missed something or there's been follow up since since then, nothing was ever done to show that the early spectacular vl drops with high dosing riba translated into a meaningful difference in SVR. Same reason I choose to remain sceptical of PIs. Looking forward to being proven wrong in the near future.

[FlGuy]

I think I have the link, bit not on the pc I'm using now.  I spent a few minutes searching but did not come up with it yet.  If I can locate it, will post a link.

[jmjm530]

You're probably then familiar with their two year old pilot study where 9 out of 10 geno 1's achieved SVR with high dose ribvirin. Lindahl also had an earlier paper suggesting the correlation between anemia, serum riba levels and I believe RVR, but not sure on the latter. The more recent papers such as I posted and FlGuy is looking for show a relationship between anemia, RVR and SVR. Also, a number of studies suggest that weight-based ribavirin is better than flat dosed, which does support that more riba is sometimes better. Like yourself, I'm unaware of any published follow-up by Lindahl except for the study on the saturability of ribavirin which isn't really relevant unless you dose over 2000 mg/day. On the other hand, I really haven't been searching for any of the studies for quite some time, so stuff may be out there if you look. My personal feeling is that there are a number of ways to beat the odds, with high dose riba being one of them. However, with the newer PI's, etc, in trial, I doubt that high dose riba will get much trial effort in this country as the moneys no doubt will go to the newer drugs for a number of reasons including the toxcicity of riba at very high doses and how many doctors here are willing to put the time and effort in dealing with the side effects. I believe two out of the ten in the Sweedish study required two blood transfusions each. Both, however, did SVR.

-- Jim

[nygirl7]

Tomahto.