4 Wk. PCR Results ! ????????

[kickboxingmom]

I got my 4 wk. PCR results ! I just got home and don't want to look up and figure out.Dropping o's etc.Thank you for looking ! Thank You !       My start viral load was       772575     5.89 H
HEPTIMAX   (R)   HCV   RNA        Out of range 122000   H       < 5  IU/mL          
HEPTIMAX   (R)   HCV   RNA        Out of range 5.09       H       < 0.70  log  IU/mL
By the way my HGB went from  9.8 from the 3rd. to 11 today ! I can breath better !
Thank you before hand.
Tammy

[jmjm530]

If that's a concern, one strategy might be to start the Pegasys switchover earlier than day 7 of the cycle.  Tightening the cycle a bit (i.e. increasing the dose)  isn't a bad strategy for a null responder anyway and in fact, depending on how agressively one wants to treat, both could be used simultaneously.

-- Jim

[zazza]

My concern was that if you switch from PegIntron to Pegasys  there will be days when the PegIntron has practically left your body and the Pegasys has not yet come to its peak level. An opportunity for the virus with little interferon in the body? Of course if you truly are a null responder, I guess it does not matter if you switch pegs, since you are not responding to the peg you are on anyway.

[jmjm530]

as stated by the study you quoted,the concentrations of the respective pegs in this sense do not translate into a viral response, which was the whole point of this discussion and why I took issue Zazza's concern. it was therefore not the levels per se but the different formulations. I doubt this is been studied, but it's not unreasonable to retreat with a different peg then initially used. Therefore changing pegs in a non-responsive patient seems one of many reasonable strategies.

[CoWriter]

"if that weren't true, then wouldn't peg intron in theory have more RVR's? In other words, wouldn't it hit the system faster in week one?"

------------------------------------


http://www.projectsinknowledge.com/Init/G/1710/index.cfm#3


"At weeks 1 and 4, the serum trough concentrations of peginterferon alfa-2a were 16 and 25 times greater, respectively, compared with peginterferon alfa-2b. This increased concentration did not translate into greater antiviral efficacy, however, in that peginterferon alfa-2b demonstrated a significantly greater mean area under the curve (AUC) (ie, cumulative) viral load reduction compared with peginterferon alfa-2a at both weeks 1 and 4 (Figure 7).31 In addition, the mean maximum log10 viral load reduction at weeks 1 and 4 was also significantly greater for peginterferon alfa-2b compared with peginterferon alfa-2a"

Co
P.S.  Sorry....took me a "few" days to find it....LOL

[kickboxingmom]

I do not have anything related to blood sugar.On Dec.03,Hepa did do an (HFP), Hepatic Function Panel.I have a daughter whom is an ER Nurse.Only been working a yr and a half.She's also learning with me about the HCV.She lives in TX.I'm in MO.
I will take all this info to my rheumatologist and hepatologist.Very interesting links you provided.
CoWriter I think I covered everything you ask.If you need me to e-mail you copies of what I have let me know.
I thought I was doing good getting copies everytime I go see a doc.Learning as we go.
Again, Thank You so much.I'll be looking for the bills in my mail box,lol.
I'm sure some of the people on this forum would not have a problem if they wanted to be Drs.My 17 yr. old daughter has just been notified by the asst. dean of U.M.K.C.
She already has an appt. with a cardiologist to do clinicals with him for two days over Christmas break.She wants to be a Dr.so bad.She has the grades and desire.So you see I respect what you do for a living.Thank you.
Tammy

[kickboxingmom]

Your sweet.
Tammy

[kickboxingmom]

First of all, I know you are busy but yet you took the time to make sure I had the links to prove what I say.You are one caring person to do that as are the others.Thank you so much.
Yes, rheumy Dr. did do the urine culture and antibiotics was then started.I had been fighting with my first uti for eight or so months.
My primary was told several times and done cultures.He said, go home, drink lots of OJ and you'll be fine.
It was my rheumy who found ALL the things wrong with me.I have very high respect for the woman.I found out in Nov. of 07.She put me on a generic for ocycotin.It was helping with the pain.two months and Ins. said, no we won't cover that anymore but did approve morphine.I had been taking ten months prior to starting Peg-Intron.
Last visit with her she told me next appt. we will talk about Enbrel.
Yes she did tell me about the autoimmune problems I may be facing but I really don't think she knows about the morphine.I may be wrong, but I copied all the links you gave me and have a package for her on Monday morning.Thanks to you, she will know ! She has to change the morphine or take me off asap.I guarantee if she didn't know, she will be ON IT.
Blood pressure.I haven't monitered the numbers lately, but when I do the Benicar has it stabalized.It was borderline to start with three yrs. ago.I keep asking primary to change it or take me off.I'm due to see him before next re-fill at first of month.
I have to self cath because of a radical hysterectomy thirteen yrs. ago.I think that was the cause for uti.I di trust my Drs.and I'll copy and print your latest links.I have to run to the store before they close so I will continue in a little minute.
Tammy

[charm27]

Wishing you well!!!!!!!!!!!!

[CoWriter]

I am hoping your doctors told you that Hep C treatment can cause severe rheumatoid arthritis flare ups and they'll be watching you closely.

Because if they didn't tell you then they'll have nothing on the list of "Things done right"....and you deserve better than that.  

Co

[CoWriter]

"WBC  was 12.1 out of range."

"I have never had staph.My husband say's I've always been the healthiest person he knows.Untill all this."
-------------------------------

The UTI would have caused the high white cell count (WBC).

The result from the urine culture (I hope they did one) would tell you whether the UTI was caused by staph (which is very common) or by something else.



"Rheumy started tx with morphine for RA because I was going to start tx."
----------------------------

I have seen people who had been taking Morphine for a long time reach SVR.  But starting the Morphine at the SAME TIME as treatment was probably not the best move.



"Should I ask to be taken off the morphine ? It doesn't seem to be helping anyways."
------------------------------
Do not stop taking it on your own because stopping Morphine can also increase the viral load.  Discuss it with your Rheumatologist (show him the studies on Morphine from the two links I gave).  If he decides to stop it he may want to decrease it slowly.  



"I'm sorry, unless it's on on of my two CBC's I don't have a fasting blood sugar level."
-----------------------------

They must have done it at baseline.  It's usually done on the same test that checks your liver enzymes.  And I doubt they would have started treatment without checking the liver enzymes.  From now on, make sure you get a copy of all your blood work.  There are lots of eyes in this forum that can help you spot problems.



"Looking at my standing order for blood draws I noticed,
Week 12-before 13th injection   CBC, CMP, TSH  I won't have that Comprehensive Metabolic Panel until then."
------------------------------

You can't wait that long.  You see... insulin resistance is frequent in people who have rheumatoid arthritis.  Multiple studies have shown that fasting insulin levels and HOMA test (which checks for insulin resistance) scores were significantly higher in all patients with rheumatoid arthritis.  

http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijrh/vol1n1/tnf.xml


Make sure you remind your doctors of that.  Looks like they may have forgotten.  Plus, you also have high blood pressure....also linked to insulin resistance.  They need to take care of it now to give you a better chance of SVR.  

Let me give you some links to studies that will show them why testing for, and treating insulin resistance is so important, just in case you have to convince them.  The first study talks about insulin resistance causing extra insulin to be produced.....and having too much insulin makes interferon ineffective.  

I commend you for your proactive approach and positive attitude.  You can do this.  Let me know if there's anything else I can do to help.

Co


"interferon alpha blocks HCV replication. However, when insulin (at doses of 128 microU/mL, similar that seen in the hyperinsulinemic state) was added to interferon, the ability to block HCV replication disappeared"

http://scielo.isciii.es/scielo.php?pid=S1130-01082006000800006&script=sci_arttext


"Insulin-Resistance in Chronic Hepatitis C patients: New Predictor of Sustained Virological Response Independent of HCV Genotype and Liver Fibrosis Stage."

http://aasld.scientificposters.com/epsAbstract.cfm?id=37


"Glucose >100 mg/dl Reduces Interferon/RBV SVR"

http://www.natap.org/2008/HCV/031008_01.htm


"Therapies to Manage Insulin Resistance Improve Response to Interferon-based Therapy in Chronic Hepatitis C Patients."

http://www.hivandhepatitis.com/2008icr/aasld/docs/112108_a.html

[kickboxingmom]

Looking at my standing order for blood draws I noticed,
Week 12-before 13th injection   CBC, CMP, TSH  I won't have that Comprehensive Metabolic Panel until then.
Tammy

[kickboxingmom]

Like I said, if it was easy, everyone would tx.Look at what you've been through.You didn't have the heart to tell me.That was sweet of you.I have to go to work.I'm going to print out the links CoWriter sent, take them to my hep and rheumy.I'll take it from there.
Rheumy had me on Methotrexate and oxycotin before tx.Insurance would not pay for the generic oxycotin so they agreed to pay for morphine.We dropped the methotrexate but kept me on morphine for the rheumatoid arthritis.
I took riba this morning but am waiting awhile to take others.It probably doesn't matter.
It'll all work out in the end.Tonight is 6th. injection.I'll find a way.
Again thank you to ALL !
Tammy

[jmjm530]

actually, the opposite of what you state is true, although the trials were flawed because of different riba levels. And as two trials, showing one etc. or were the other, you do realize that the winner invariably have that trial funded by the respective manufacturer. That said, I did take the possibility of such an event into consideration in the per post dosing scheme.

Regards,

Jim

[CoWriter]

"if that weren't true, then wouldn't peg intron in theory have more RVR's?"
----------------

It does.  But the SVR numbers are usually pretty even.

Co

[Bill1954]

Hi Tammy,

I seriously doubt a glucose test would be included in a CBC. You might look for it in a CMP (Comprehensive Metabolic Panel) though. Sorry you’re going through this; I began to write you a response when you initially wrote this thread, then deleted it because I didn’t have the heart to tell you that you were having a slow response. This **** can be so discouraging sometimes. God luck going forward; I’ll be looking for your progress.

Take care—


Bill

[kickboxingmom]

Thank you All so much.It's 11:00 here and I'm tired so will deal with this again tomorrow afternoon.Thank you so much.I mean that.I think the morphine and RA have alot to do with this issue.I read and will copy post from CoWriter and drop them off at my Drs. offices tomorrow and take it from there.Who says Mondays are bad ?lol
Tammy

[kickboxingmom]

I'm sorry, unless it's on on of my two CBC's I don't have a fasting blood sugar level.
Tammy

[kickboxingmom]

Thank you ! I have never had an uti and after dx of HCV,1A Stage 1, Grade 0.Rheumatoid Arthritis. All in Nov. 07.I had a cbc from hep doc and hgb was 15.4 WBC  was 12.1 out of range.Someone ask why my wbc was elevated and ask if I had had an infection or cold recently.I went to rheumy and she said, uti.tx it and it got better...
Rheumy started tx with morphine for RA because I was going to start tx. Insurance fought me till this past Nov. and my first shot was Nov.07.I have never had staph.My husband say's I've always been the healthiest person he knows.Untill all this.
Should I ask to be taken off the morphine ? It doesn't seem to be helping anyways.I can take hydrocodone as needed for pain but I try not to.Thank you so much.You have also provided links to give to Drs.I appreciate your time.
Tammy BTW-Nice to meet you.

[CoWriter]

"one last thought is the morphine sulfate and how it may impact on all this. I'm whistling in the dark here, just a thought."
-----------------

Studies showed that Morphine enhances HCV replication in hepatocytes.  Also, Morphine compromised the anti-HCV effect of recombinant Interferon- alpha.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17674315&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum


HOWEVER.....

Morphine Withdrawal also Enhances Hepatitis C Virus Replication.

http://ajp.amjpathol.org/cgi/content/full/167/5/1333

Co

[CoWriter]

"pre-treatment hemoglobin was 15.4 H because f a urinary tract inf.Nov.07th. 1st. shot.
Dec.03, hemoglobin 9.8 "
----------------------

If the urinary tract infection was caused by STAPH, that may account for the big drop in hemoglobin.  Staph decreases hemoglobin.  

http://jb.asm.org/cgi/reprint/188/24/8421.pdf



"Morphine Sulfate ER15mg. RA.Then 3 riba."

------------------------

Does the "RA" mean you have Rheumatoid Arthritis?  Because Rheumatoid Arthritis often causes anemia.


The Hepatitis C virus can cause you to become insensitive to insulin (even if you exercise and eat healthy) ...and infections (like a urinary tract infection) can make the blood sugar go up.  When the blood sugar goes up, the pancreas produces extra insulin.....and too much insulin, makes interferon ineffective.  

That could certainly account for the viral load not going down faster.  Would you happen to know what your fasting blood sugar is?  

Co

[kickboxingmom]

I think jmjm was just using as a for instance.Alot of maybies.Thinking outload so to speak.His mind was not on focusing changing as to examining diet and putting meds together with ribavirin and such.I will talk to my hep doc as soon as he's back in town.
I will do further research and beat this.By 12 weeks.One thing I didn't realize until your hgb drops how bad it can make you feel.I was mostly concerned about missing work.
Sometimes a day off once in a while is a good thing.I have to get off here and get ready for work tomorrow.I'm getting done early so I can atleast call my Drs.Your help is appreciated over and over I will say this,Thank you.
Tammy    I have been through alot in the past three yrs.If I told ya's you wouldn't beleive half the stuff.This is just another stepping stone.I just have to climb a little higher and hang on a little tighter.I have a will.I will NOT look back.It will be done the best it can be.This does not discourage me.It will make me stronger in the end.It will be otay.If it isn't, tell me now.You guys did, lol.No really, it's gonna be good.Look at zazza and all the others.If it wasn't a fight, it wouldn't be worth fighting for ! Thanks Guys and Gals,
Tammy

[jmjm530]

first sentence should have read in part "if that WERE true"

[jmjm530]

if that weren't true, then wouldn't peg intron in theory have more RVR's? In other words, wouldn't it hit the system faster in week one? That said, if this was a concern, combining the switch with an increase in dose would tend to counteract this theoretical effect. You might therefore, take the first injection of Pegasus at day three as oppose today seven on the switchover week. Or other such possibilities. And no, I haven't seen any studies on this LOL

[zazza]

I think I have heard that you have to be weary if you switch from PegIntron to Pegasys because of their different half lives. There might be a gap because PegIntron leaves the body quicker, and Pegasys takes longer to reach its maximum level. CS, where are you when we need you? I am not that good on this.