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treatment questions!!! answers please! (viral load and treatment time)
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treatment questions!!! answers please! (viral load and treatment time)

hello everyone! just to update for those who dont know im 21 year old female 5'7 and weigh 180lbs. found out i had hep c in june 2012 i was devasted cause i knew all to welll that i did this to myself:( i am an ex-IV user amd i know thats how i contracted the virus and i know it had to be sometime within the year 2011 cause that was when i got into that horrible sad lifestyle(which thankfully is not apart of my life no more one and a half years clean!) so the virus was dectected relativly early being that most people dont find out until decades after. i started treatment on feb 28th 2013 i am now on day 5 and havent had one single side effect! (thank god) i have a viral load of 14500 i go to my lab on the 13th for bloodwork and the 15th ill go see my doctor to see how things are. i wonder what we will talk ablout that day. then on the 28th ill be at my four weeks and starting the victrillis, i wonder if thats when ill start having side effects? i take my shots on thursday mornings and the riba at 10am and 6pm every day so far so good! isnt it important to take this pills at the same time everyday??? what i also want to know is on the fourth week when i go back to the doctor what will it take for me to only have to do the 28 week treatment if im undected at 4 weeks then will i only have to do 24 more weeks?? or since im on the victrillis (which from what i read isnt as potent as the incevec?)then will i have to do 44 more weeks? my doc initally told me id be doing 48 weeks im just curious to know! also i wanted to know since my viral load is low and i found out about it kindza early and im young do i have a better chance of curing!? im so grateful for this community nd all who contribute to helping others through something like this its amazing any input wouyld be great! thanks everyone
23 Comments Post a Comment
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3230925_tn?1397619565
Welcome to the forum and congrats on being clean.Since you just contracted the virus recently you must have no liver damage at all,which is a big plus for you.Your a woman and still young which is another big plus for you.These things I mentioned alnsl gives you a better chance in achieving a SVR .If you don't get a  RVR yes you would have to do 48 weeks.Not everyone reacts the same way with side effects.Are you doing a weight base ribavirin dosage intake? If not this is something that should be seriously considered.

Best wishes

Dannyboi7
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Avatar_f_tn
I'm not sure if I'm doing a weight base dose or not I know I'm on 1000 Mgs and so far haven't had one side effect do you think I should be on more than that for my weight?
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Avatar_m_tn
A couple things come to mind here, first I agree there is probably very little damage. You had a very low Viral count to begin treatment with. I would not be surprised if at 4 weeks you are not already und, even before the start of victrelis... I would want to know if thats the case then what his thinking is. To me 48 weeks would then be overkill and really not needed. Some doctors might even think twice about adding the Victrelis in that case.

Labs should help show if you are getting enough Riba, if there is not much movement in your HGB then I would question this........ Wishing you the best, I have a feeling though your going to be fine.

What young kids don't do stupid things? I think it's great your not afraid to admit it, and just maybe one person will give what you said some thought. Only the best to you.
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1815939_tn?1377995399
"then on the 28th ill be at my four weeks and starting the victrillis, i wonder if thats when ill start having side effects?"
-----------------------------------

You could start having side effects at any time or you may breeze through treatment with few side effects. Adding the 3rd drug may compound the side effects.


"i take my shots on thursday mornings and the riba at 10am and 6pm every day so far so good! isnt it important to take this pills at the same time everyday???"
--------------------------------

Yes, it is important to take them the same time every day.


"what i also want to know is on the fourth week when i go back to the doctor what will it take for me to only have to do the 28 week treatment if im undected at 4 weeks then will i only have to do 24 more weeks?? or since im on the victrillis (which from what i read isnt as potent as the incevec?)then will i have to do 44 more weeks? my doc initally told me id be doing 48 weeks"
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At the end of the 4th week (which will be 4 weeks of Interferon and Ribvirin) they will draw a VL. They will be looking to see how much of a log drop you will have. The amount of log drop you have is a predictor of response to treatment. At the end of week 8 (after 4 weeks of Victrellis) the VL will determine how long you do treatment. Viral Loads at weeks 12 and 24 are also important. There are criteria that need to be met as one moves along in treatment. With Victrellis the least amount of time you would do is 28 weeks. I am not sure why your doctor told you 48 weeks because treatment is response guided. In other works, the length of treatment time depends on how you respond to treatment. You won't know that until you treat. Incivek and Victrellis have similar SVR rates.


"also i wanted to know since my viral load is low and i found out about it kindza early and im young do i have a better chance of curing!?"
---------------------------------------

Being young, being female, having a low VL, treating early ... all go in your favor. Also, since you were just infected recently you should not have much if any liver damage and that goes in your favor.


This is from an article on response guided therapy:

"Treatment-Naive Patients"
"Boceprevir. The approved prescribing information for boceprevir in noncirrhotic treatment-naive patients recommends that all patients initiate therapy with a 4-week lead-in phase with pegIFN/RBV.[51,52] After the completion of the lead-in phase, boceprevir 800 mg 3 times daily (every 7-9 hours) should be added to continued pegIFN/RBV. Boceprevir should be administered with food, specified as a light snack or meal in the prescribing information. For treatment-naive patients without cirrhosis, HCV RNA measurements at Weeks 8, 12, and 24 are used as the decision points for response-guided therapy (Table 5). It is recommended that a real-time polymerase chain reaction HCV RNA assay with a lower limit of quantification of 25 IU/mL or below be used for evaluating virologic milestones for response-guided therapy.

For early responders (HCV RNA undetectable at Week 8) who maintain undetectable HCV RNA at Week 24, triple therapy can be discontinued at treatment Week 28. For late responders (HCV RNA detectable at Week 8 but undetectable at Week 24), treatment with pegIFN/RBV and boceprevir should be continued through Week 36, then followed with an additional 12 weeks of pegIFN/RBV through treatment Week 48. This recommendation is based on, but somewhat different than, the response-guided therapy arm in SPRINT-2 (Figure 10).[28] Late responders in this arm received an additional 20 weeks of peg/IFN/RBV (after completing the 4-week lead-in phase followed by 24 weeks of boceprevir plus pegIFN/RBV). Across both the nonblack and black cohorts, SVR rates were 75% in the 48-week arms and 66% in the response-guided therapy arm. This was considered a potentially meaningful difference, leading to the recommendation that the boceprevir phase should consist of 32 rather than 24 weeks."

http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20New%20Agents/Module/Practical_Guide/Pages/Page%204.aspx

You may have to register to read that article but it is free.
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Pooh thanks for answering all my questions so helpful!!!!! God bless you
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Thanks candoman I appreciate you and what you said!!' The best to you as well
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1815939_tn?1377995399
As far as your Ribavirin dose, I believe you are being underdosed.

The weight based Ribvirin dosage is as follows:

1000 mg/d if a person weighs   75 kg or less
or
1200 mg/d if a person weighs   over 75 kg

You weight 180 pounds which is 81.8 kg


American Association for the Study of Liver Diseases (AASLD) guidelines recommend weight- based ribavirin used for genotype 1.
*Weight-based (Genotype 1) Ribavirin dose
if using Peginterferon alfa 2a (Pegasys)
Patient’s weight Ribavirin Dose
≤ 75 kg 400 mg qAM, 600 mg qPM (1000 mg daily)
> 75 kg 600 mg qAM, 600 mg qPM (1200 mg daily

To view this table and the recommended dosage, go to the top of page 2 at this link. Be careful when reading the article because there are various dosages depending on the type of drug you are using abd the Genotype, but the recommended weight based Ribavirin for Genotype 1 is the one I posted which is and it is at the top of page 2 in that article.

http://www.anthctoday.org/community/hep/docs/HcvTxMedDosingCharts.pdf
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1815939_tn?1377995399
I should add something. The Victrellis must be taken every 8 hours at the same time each day (actually every 7-9 hours, but try to get them as close to every 8 hours as possible). This is very important so that the medication plasma levels are maintained.

With Ribavirin, the Ribavirin does have a long half life so the timing is not as critical with the Ribavirin. The main reason for taking the Ribavirin at the same time each day is to establish a schedule so that you do not forget to take them or so that you can remember if you took them or not. It is best to have a pill organizer, the weekly pill organizers so that you can set the pills up for a week and then you know if you took them or not.

If you are like many of us, you will not remember if you took them 5 minutes after you took them. So one needs a system and some reminders and a schedule is good to have, even for the Ribavirin. When you get to the Victrellis part of treatment, be sure you have an alarm clock which you set, a programmable watch, a timer which you set every time, something to have set that will go off and let you know that a dose is due.

Best of luck.
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Avatar_f_tn
That's a great possibility that I am because when I last saw the doc I was 160 and I've gained some wieght in a short amount of time I see him in 2 weeks so maybe he will up my dose thanks again for all the info:):):)
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Avatar_f_tn
Why don't many of you remember do the drugs usually effect memory? Also do you think this will lesson my chances if I don't get a up on my dose? And possibly why I'm on day 5 and still not one side?
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1815939_tn?1377995399
As far as the drug dose, I would definitely want to be taking the weight based dose that was recommended by the protocols. The SVR rates were higher for those taking the correct weight based dosage. I would not wait for 2 weeks. I would call the doctor tomorrow and explain the situation, that you weighted 160 when in his office but that you actually weight 180 pounds now, 81 kg now, and that your dose is too low according to weight based dosing. Ask him if you can increase it to the proper dosage. I would think he would want you to take the correct dosage. I would not wait. I would call him tomorrow. The meds are very important in the beginning of treatment too, and you are currently in the process of building up a plasma level of Ribavirin. You want to get that level up to appropriate level as soon as possible so that the Interferon and the Riba can work together to create an antiviral state so that the drop in viral count is significant at the end of week 4.

Yes, the drugs affect the memory. In fact, they affect a lot to do with the brain. The Interferon interferes with neuro transmission. It is what causes a lot of the various side effects, the neurological side effects, and the brain fog (as we all call it).

It is not just memory. Yes, it affects the memory, and many here will tell you that they could not remember what they did 5 minutes after they did it (Maybe even 2 minutes after they did it). Or one would go into a room and have no idea why one went into that room. Or, forgetting what one is saying in mid-sentence. Missing familiar turnoffs. Many people stop driving on treatment because they are so spaced out. Inability to concentrate and/or do abstract thinking. I would not read a book while on treatment. The words went in one eye and out the other. I cold not add very well or calculate. I could not concentrate at all. I could not write letters. No concentration to form words. People try to open their garage doors with TV remotes or they try to make a phone call on their TV remotes. People make coffee with no coffee beans in the filter, LOL. Or they forget to grind the beans. People cannot remember words or names, familiar words and names. I swear my vocabulary dropped to that of a 6 year old while I was on treatment. All of the "big" words left my vocabulary.

I don't know if this will happen to you or not and I don't know to what degree it will happen, but it is best to be prepared when it comes to the pills and have a schedule and system to be sure you remember to take the pills when you are supposed to take them.

You are younger and that should help you. I think the older one is the more side effects one has, although that is also not always true.

The good news is, the side effects normally disappear after treatments. I finished treatment about 27 weeks ago and almost all of my side effects, including brain fog, are gone. I feel great, better than I have for 19 years.

Enjoy your lack of side effects while you can. That could change any time. Some people have few side effects and you may be one of them.
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Avatar_f_tn
I agree with Pooh. I wouldn't wait 2 wks to ask for the increase in riba. I would call tomorrow and ask.
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thank you  pooh for all the feedback i called my doctor today could only get ahold of my nurse tho i explained to her what i learned from you she looked back in my history and it turns out i was wrong i actually wieghed 172lbs not 160 so its only an lb diference so that was the wieght he knew i was starting treatment on (the 172) she said thats usually the dose he always gives and she thinks its right but i asked her to mention it t him anyway just to be sure cause i want to make sure i im doing this right! she is to call me once she hears from him. im on day six and still not one single side hopefully im on the right dose that i should be on and im just one of the lucky ones
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Avatar_m_tn
Being your only on day 6 the Riba would not yet be causing any of the main side effects like aneima or the Riba rash. It is the interferon that causes the flu like feelings and for the most part that is mainly a day or to after the shot..... Don't stress over this, we have seen this here before. Labs will tell the tell, trust me I am sure you will soon be wishing for these days as treatment goes on
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1815939_tn?1377995399
Well, if you weighed 172 then, according to the recommendations, you are still being under dosed with Riba.

172 pounds equals 78.2 kg.

You can look at the charts and see that you are being under dosed.

American Association for the Study of Liver Diseases (AASLD) guidelines recommend weight- based ribavirin used for genotype 1.
*Weight-based (Genotype 1) Ribavirin dose
if using Peginterferon alfa 2a (Pegasys)
Patient’s weight Ribavirin Dose
≤ 75 kg 400 mg qAM, 600 mg qPM (1000 mg daily)
> 75 kg 600 mg qAM, 600 mg qPM (1200 mg daily


Let me put it this way, if you stick with the dose you are on, which is lower than recommended for your weight, and you attain SVR (cure), fine. But if you stick with the dose you are on, which is lower than recommended for your weight, and you fail treatment or relapse, you will always wonder if you would have attained SVR (cure) had you been on the correct dose to begin with. This is not an easy treatment. It is better to get it right the first time and only have to do it once.

I know you are close to the cut off weight for 1000 mg versus 1200 mg, but why take the chance. Your doctor should know this and he should be following the recommended treatment protocol. It would make me nervous to be told my doctor "thats usually the dose he always gives." That implies he is not doing weight based treatment (perhaps he is, but the statement implies he is just giving 1000 mg to everyone). The experts came up with the recommendation to do weight based Riba based on studies which show that weight based treatment has better SVR rates than just prescribing the same dose to everyone.

If it was me, I would want the right dose in order to give myself the best chance for SVR. You may have to keep calling them.
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Avatar_m_tn
I agree you should be on weight base dose, but at day 6 that is not why your not feeling the side effects... Once again its the interferon that is the main cause of the flu like problems that we read about here. If you are worried see if the nurse can give you the next shot to make sure you are getting the correct dose and all of it.
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1815939_tn?1377995399
I agree with Can-do-man about the side effects.
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3230925_tn?1397619565
   Like others have said up your rib intake to put all chances on your side.If I may I would like to share  my experience of treatment and what I did,in any way you shouldn't follow this example,because it is different for everyone.And you should take in consideration first and for most to what your medical team says ,for one none of us here are doctors.

   I was a G3 who did treatment last year and I'm now SVR.At first I was worried I wasn't responding to the interferon,didn't feel anything until the 3rd shot,then it was like HELLO  oh thats what they are talking about ! Then I got pretty severe side effects the rest of treatment.I'm 6'1" weighed 180 lbs when started treatment,they only put me on 800mg a day of rib throughout treatment.By week 12 I weighed 150 lbs and stayed that way until now,this shouldn't be a worry for you because some people gain weight during treatment.I didn't get a RVR but was UND at week twelve.Now for a G3 not getting a RVR isn't a good thing,it lowers your chances of a SVR.I had one good thing going for me I was compliant with 100% of my meds throughout the whole treatment,I have a feeling that was my saving grace.I'm not sure sharing my story is of any help to you.

Best wishes

Dannyboi7
  
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Avatar_f_tn
well done orf getting clean and staying clean.Yes it can affect memory hubby terrible but hoping that will change soon. Not sure about which drug is doing it, but learnt through thie site alot of people suffer with pgy fog, i think that true. Good luck to you and i hope that the sx stay away
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Avatar_f_tn
Hey all thanks for sharing! My nurse just called me she let my doctor know that I wasn't having sides at all and about my concern of the RIBA dosage she told me my doctor says its great that I'm no sx so far and that I am on the correct dose of meds! I really hope he's right I trust my doctor but I'm still having doubts and I'm not very good at talking to people I told him once I know you guys think I should push on being sure but I think for now I will just wait one more week till my appointment and make sure I get a reason for the dose my doc said communication is key to get through this we got to work together and I want to know everything. Do they ever base the dose of RIBA on how low your viral load is?
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Avatar_f_tn
But I do agree with you I really want to make sure I do this right it's so important to me! I only want to have to do this one time!!! Tomorrow I take my second shot! This first week has been great I hope it last
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1815939_tn?1377995399
"Do they ever base the dose of RIBA on how low your viral load is? "
---------------------------------

The answer to that question is no.


If your doctor still thinks he is correct, maybe you should show him the recommended guidelines/protocol so that he can see in black and white that you are, according to the recommended guidelines/protocol, being under dosed.

American Association for the Study of Liver Diseases (AASLD) guidelines recommend weight-based ribavirin used for genotype 1.
Rev. 12/12

*Weight-based (Genotype 1) Ribavirin dose if using Peginterferon alfa 2a (Pegasys ®)

Patient’s weight Ribavirin Dose
≤ 75 kg 400 mg qAM, 600 mg qPM (1000 mg daily)
> 75 kg 600 mg qAM, 600 mg qPM (1200 mg daily)

Top of second page:

http://www.anthctoday.org/community/hep/docs/HcvTxMedDosingCharts.pdf


DOSAGE AND ADMINISTRATION
Chronic Hepatitis C
PEGASYS/COPEGUS Combination Therapy
The recommended dose of PEGASYS when used in combination with ribavirin for chronic hepatitis C is 180 meg (1.0 mL vial or 0.5 mL prefilled syringe) once weekly. The recommended dose of COPEGUS and duration for PEGASYS/COPEGUS therapy is based on viral genotype (see Table 1).

The daily dose of COPEGUS is 800 mg to 1200 mg administered orally in two divided doses. COPEGUS should be taken with food.

Table 1: PEGASYS and COPEGUS Dosing Recommendations
Hepatitis C virus Genotype PEGASYS Dose
(once weekly) COPEGUS Dose (daily)
Genotypes 1, 4 180 mcg < 75 kg=1000 mg
                                        ≥ 75 kg = 1200 mg

http://www.rxlist.com/pegasys-drug/indications-dosage.htm



Ribavirin Dosage and Administration Chronic Hepatitis C Monoinfection

The recommended dose of Ribavirin tablets is provided in Table 1. The recommended duration of treatment for patients previously untreated with Ribavirin and interferon is 24 to 48 weeks.

The daily dose of Ribavirin tablets is 800 mg to 1200 mg administered orally in two divided doses. The dose should be individualized to the patient depending on baseline disease characteristics (e.g., genotype), response to therapy, and tolerability of the regimen (see Table 1).

Ribavirin tablets should be taken with food.
Table 1. Peginterferon alfa-2a and Ribavirin Tablet Dosing Recommendations

Hepatitis C Virus (HCV) Genotype Peginterferon alfa-2a Dose* Ribavirin Tablet Dose Duration
Genotypes 1, 4 180 mcg < 75 kg = 1000 mg
                        ≥ 75 kg = 1200 mg

http://www.drugs.com/pro/ribavirin.html


Ribavirin Dosing Information
Usual Adult Dose for Chronic Hepatitis C:

TABLETS:
In combination with peginterferon alfa-2a 180 mcg subcutaneously once a week:
Genotypes 1, 4:
Less than 75 kg: 1000 mg/day orally in 2 divided doses for 48 weeks
75 kg or more: 1200 mg/day orally in 2 divided doses for 48 weeks
Read more at http://www.drugs.com/mtm/ribavirin.html#yKoVllruGFmPwB2o.99

http://www.drugs.com/mtm/ribavirin.html


There is a different table for dosing if you are taking peginterferon alfa-2b,  but most of us are on peginterferon alfa-2a. If you are taking Pegasys, then you are taking peginterferon alfa-2a.
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Avatar_m_tn
While I agree on what the label says I am not sure at this time it's really a fight you want to pick with your doctor... You stated your weight was 172 for starting treatment. (correct) And I;m guessing you were wearing clothes, the cut off is 165lbs so were really only talking about a very few pounds compared to 200mg of more Riba... Myself I would wait and see how your labs are, if your HGB does not drop any then I would then question him.......... Just my thoughts
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