Aa
I Am Coming Back For 2nd Go At Tx
Long story short Hi there I'm Steve in Sydney, Australia I have Hep-C Geno 3a I did Pegylated alpha a + Rib for 6 months in 2002-03 . I was PCR neg but 1 month later started ALT's rising & of course Hep-C came back. Now its 2009 & my team has me starting a new Tx which is basically same except they said this Interferon is the "B" pegulated alpha & I will be taking 7 Rib this time instead of 4 I took last time ... I start in mid March & I will be frequenting this forum like I did last time on Tx , it really helped me ... This time is going to be tougher I think , double the time & almost double medication. I want to ask if anyone knows about "Sustanon 250" I have a shot every 4 weeks (testosterone) some say that it may be toxic to my liver & if this is true I will delete it from my life. I will ask doctors on my next visit & see they think I should continue or completely sack it. I'm low in testosterone thats why my GP started me on it.... Is it toxic for hep-c patients ..... Thanks everyone I will see you around the forum for sure ....
So good to hear from a few of you tough people doing Tx I know how we have to get in our own head & be so strong .... It will be the hardest thing I've ever had to do again but double the time LOL I gotta keep smiling & I will be writing on these pages
Jim I dont know sensitivity but it was after Tx ... I was UND at about 4wks .... Thanks All ...
Jim I dont know sensitivity but it was after Tx ... I was UND at about 4wks .... Thanks All ...
Another G3a (across the ditch also) chiming in to welcome you back Steve. I've tx'd twice (first time without riba or peg'd IFN), and have recently finished 6 months Pegasys/riba tx (for my 55kg weight I was on 5 riba).
All the very best for this time around; I hope your Prof is supportive of what this site brings to the table with regards your personalised tx; I do know it's easier to push for a personalised plan prior to tx rather than pushing during sx time!!!
All the very best for this time around; I hope your Prof is supportive of what this site brings to the table with regards your personalised tx; I do know it's easier to push for a personalised plan prior to tx rather than pushing during sx time!!!
lots of good advice here - check on getting weight-based RBV , get tested for IR, see about longer duration. However, I think one of the best suggestion is from your 'cuzzie across the ditch. R7128 is one of the most promising new drugs and though there are few opportunities for trials worldwide, Australia is one of them.
Australia and NZ are also sites for an interesting trial that will combine two HCV-specific drugs and bypass INF altogether - though it will be restricted to G1s:
http://files.shareholder.com/downloads/VRUS/0x0x248393/22984af4-303c-4721-b085-cf81be2cf557/VRUS_News_2008_11_10_General_Releases.pdf
Australia and NZ are also sites for an interesting trial that will combine two HCV-specific drugs and bypass INF altogether - though it will be restricted to G1s:
http://files.shareholder.com/downloads/VRUS/0x0x248393/22984af4-303c-4721-b085-cf81be2cf557/VRUS_News_2008_11_10_General_Releases.pdf
Apology accepted. Thank you.
"Its actually better to underestimate your odds."
I think the key is not to underestimate the enemy. You have to do all in your power to win this battle. No shortcuts.
You know my opinion is the same as yours. Genotype 3 is as hard to beat as genotype 1. The only difference is that so many more 3s RVR, and therefore SVR.
Estimating one's odds of SVR is an act of balance, You should not overestimate them, but you should still have a realistic hope to motivate you. And as a relapser you have hope if you treat long enough and strong enough.
My tx started with these words of my nurse: "The enemy is strong. We will use all the ammunition we have in our attempt to beat it." I lived by this. Doing everything I could to up my odds.
"Its actually better to underestimate your odds."
I think the key is not to underestimate the enemy. You have to do all in your power to win this battle. No shortcuts.
You know my opinion is the same as yours. Genotype 3 is as hard to beat as genotype 1. The only difference is that so many more 3s RVR, and therefore SVR.
Estimating one's odds of SVR is an act of balance, You should not overestimate them, but you should still have a realistic hope to motivate you. And as a relapser you have hope if you treat long enough and strong enough.
My tx started with these words of my nurse: "The enemy is strong. We will use all the ammunition we have in our attempt to beat it." I lived by this. Doing everything I could to up my odds.
One other thing.
Its actually better to underestimate your odds.
When you start Tx and you think G3s have an 80% chance of svr you think its going to work.
But if you use the Accelerate stats where G3s only had apx 65% svr then you have a more realistic picture of your chances.
You can then monitor Tx and make adjustments and then you might get to something like 80%.
As RVR wins anyway so the goal should be to maximise your chances of RVR.
CS
Its actually better to underestimate your odds.
When you start Tx and you think G3s have an 80% chance of svr you think its going to work.
But if you use the Accelerate stats where G3s only had apx 65% svr then you have a more realistic picture of your chances.
You can then monitor Tx and make adjustments and then you might get to something like 80%.
As RVR wins anyway so the goal should be to maximise your chances of RVR.
CS
Sorry
The problem is they are combined stats
It doesnt split G2s and 3s nor Relapsers from NRs
Its the study retreatment in Europe is based on and the results are not that crash hot
I would suspect a G3 relapser would have around 60-70% svr odds.
but that doesnt seem to be what this study achieved.
CS
The problem is they are combined stats
It doesnt split G2s and 3s nor Relapsers from NRs
Its the study retreatment in Europe is based on and the results are not that crash hot
I would suspect a G3 relapser would have around 60-70% svr odds.
but that doesnt seem to be what this study achieved.
CS
"Whether you believe it or not"
No need to be rude.
I am just talking about underdosed and undertreated relapsers. Are you?
No need to be rude.
I am just talking about underdosed and undertreated relapsers. Are you?
Also like to add that this study seemed badly designed and irresponsible, unless it's an old one. Unless I read it wrong, all genotypes were retreated for 48 weeks, which no doubt accounts for both the extremely low overall SVR rates brought down by the very low rates for geno 1 previous non responders. What were they thinking treating geno 1 prev non responders and relapsers for only 48 weeks? Either irresponsible or this study was done before the more current studies that show 72 weeks is required reasonable SVR rates.
I don't see your "44%" number. This suggests that those geno 2/3's who failed prior tx have up to a 76% SVR rate.
http://www.hivandhepatitis.com/2008icr/easl/docs/050208_b.html
http://www.hivandhepatitis.com/2008icr/easl/docs/050208_b.html
Zazza - I don't agree with those low odds for geno 3 relapsers retreating who have been underdosed and undertreated their first tx. IMO if you did not treat long enough and did not have weight based dosing you did not get a proper chance your first tx.
Whether you believe it or not 44% is what the EPIC 3 study achieved with G2s and 3s who failed Prior Peg.
CS
Whether you believe it or not 44% is what the EPIC 3 study achieved with G2s and 3s who failed Prior Peg.
CS
I was PCR neg but 1 month later started ALT's rising & of course Hep-C came back.
--------
Could you please clarify if the above is during or after treatment? Specifically, when did you first test UND on treatment and what test sensitivity was used. In fact, could you list all your viral load tests on treatment if you have them. When exactly did your ALTs rise.
As to the Pegs, its a good move to switch Pegs. Peg Intron has been used in the U.S.A. for some time and is every much as good as Pegasys. If one doesn't work, maybe the next one will. Going on weight-based ribavirin is also a good idea. How much do you weigh btw? Heed the advice about getting tested for IR, but my suggestion is to get down to an ideal weight (low BMI) prior to treatment, whatever you IR status is.
-- Jim
--------
Could you please clarify if the above is during or after treatment? Specifically, when did you first test UND on treatment and what test sensitivity was used. In fact, could you list all your viral load tests on treatment if you have them. When exactly did your ALTs rise.
As to the Pegs, its a good move to switch Pegs. Peg Intron has been used in the U.S.A. for some time and is every much as good as Pegasys. If one doesn't work, maybe the next one will. Going on weight-based ribavirin is also a good idea. How much do you weigh btw? Heed the advice about getting tested for IR, but my suggestion is to get down to an ideal weight (low BMI) prior to treatment, whatever you IR status is.
-- Jim
Liten to CS and get tested for insulin resistance. IR causes low testosterone. And IR lowers your chances of SVR greatly.
Co
Co
I don't agree with those low odds for geno 3 relapsers retreating who have been underdosed and undertreated their first tx. IMO if you did not treat long enough and did not have weight based dosing you did not get a proper chance your first tx.
Long enough would be 36-48 weeks if not UND by week 4. There are studies going on now to determine whether 36 or 48 weeks is the ultimate tx duration for geno 3 slow responders.
Correct weight based dosing for a geno 3 would be at least 12 mg riba per kilo. Maybe even as much as is suggested for geno 1s, which is 13-15 mg riba per kilo.
So if you have the correct weight based dosing and the correct tx duration this time, my belief is that you have the same odds as a naive geno 3.
Best wishes for your second tx,
Za
Long enough would be 36-48 weeks if not UND by week 4. There are studies going on now to determine whether 36 or 48 weeks is the ultimate tx duration for geno 3 slow responders.
Correct weight based dosing for a geno 3 would be at least 12 mg riba per kilo. Maybe even as much as is suggested for geno 1s, which is 13-15 mg riba per kilo.
So if you have the correct weight based dosing and the correct tx duration this time, my belief is that you have the same odds as a naive geno 3.
Best wishes for your second tx,
Za
Thanks for your kind welcome & in reply to cocksparrow I have never heard of the IR thing before & it sounds interesting I will ask my doctor on the 13th march when I see him, he's a professor so he will know all about it ... Don't like the sound of those odds in that study you mentioned, my odds last time I did Tx was 80%+ to be cured ...
I'm hoping like you all say this time I will SVR because of higher Ribavirin, 7 ...
I'm hoping like you all say this time I will SVR because of higher Ribavirin, 7 ...
Hi Steve
I am on the Gold Coast, so I am just up the road, well a 1000ks or so up the road.
Since December 1st Peg-Intron (PegIFN alpha 2B) has been approved for retreating prior Tx failures in Australia. Peg-Intron is also approved in Europe for retreatment.
This approval is based on the EPIC3 study.
Overall the SVR rates of the EPIC3 study are not that crash hot.
37% achieved UND at 12 weeks and of those 57% SVRed.
If you weren’t UND at 12 weeks the SVR rate was 4%.
So if you are not UND by then treatment goes no further.
The SVR rate for G2s and G3s was 44% who failed previously using PegIFN.
The G3 rate will be lower than 44%.
So you should be looking at ways to improve those odds if you can
You should find out if you are Insulin Resistant.
G2s & 3s who have a HOMA-IR score above 2 are 6.5 times less likely to SVR than when HOMA is below 2. see below.
Mind you getting a Dr to actually give you an Insulin test aint that easy.
Now if you are IR then I would put treatment off until you have got IR under control.
Retreating in Aust is not that easy to get, so make the most of this one.
Personally I would drop the testosterone.
Wish you Well
CS
Insulin resistance and response to therapy in patients infected with chronic hepatitis C virus genotypes 2 and 3
Journal of Hepatology 48 (2008) 28–34
By linear regression, body mass index (P < 0.001) and fibrosis stage (P < 0.001) were independently associated with HOMA-IR.
After adjusting for fibrosis stage, patients with HOMA-IR of 2.
Conclusions: Even in treatment-responsive genotypes 2 and 3, high HOMA-IR is associated with a reduced response. Improving insulin sensitivity may be a useful adjunct to anti-viral therapy in these individuals.
I am on the Gold Coast, so I am just up the road, well a 1000ks or so up the road.
Since December 1st Peg-Intron (PegIFN alpha 2B) has been approved for retreating prior Tx failures in Australia. Peg-Intron is also approved in Europe for retreatment.
This approval is based on the EPIC3 study.
Overall the SVR rates of the EPIC3 study are not that crash hot.
37% achieved UND at 12 weeks and of those 57% SVRed.
If you weren’t UND at 12 weeks the SVR rate was 4%.
So if you are not UND by then treatment goes no further.
The SVR rate for G2s and G3s was 44% who failed previously using PegIFN.
The G3 rate will be lower than 44%.
So you should be looking at ways to improve those odds if you can
You should find out if you are Insulin Resistant.
G2s & 3s who have a HOMA-IR score above 2 are 6.5 times less likely to SVR than when HOMA is below 2. see below.
Mind you getting a Dr to actually give you an Insulin test aint that easy.
Now if you are IR then I would put treatment off until you have got IR under control.
Retreating in Aust is not that easy to get, so make the most of this one.
Personally I would drop the testosterone.
Wish you Well
CS
Insulin resistance and response to therapy in patients infected with chronic hepatitis C virus genotypes 2 and 3
Journal of Hepatology 48 (2008) 28–34
By linear regression, body mass index (P < 0.001) and fibrosis stage (P < 0.001) were independently associated with HOMA-IR.
After adjusting for fibrosis stage, patients with HOMA-IR of 2.
Conclusions: Even in treatment-responsive genotypes 2 and 3, high HOMA-IR is associated with a reduced response. Improving insulin sensitivity may be a useful adjunct to anti-viral therapy in these individuals.
I Steve, welcome back. There seem to be lots of people with G3 who haven't fared well with lower dosages of Riba. Hopefully this time will be successful for you. I'm taking 6 riba a day and am G3 and UND.
As to your question about Sustenon - I'm somewhat knowledgable about steroids and their individual profiles. Sus has very low toxicity to the liver. Matter of fact, most test-based injectible steroids are relatively mild on the liver. It's the pills you have to worry about.
I'm surprised your doc has you on Sus 250 every week. That's a lot of test for just hormone replacement therapy. There is some added risk for high blood pressure with testosterone, so watch out for that. How long have you been on Sus? I would eat healthy and get in some exercise while you're doing it, because it will make you eat a lot and you can gain a lot of weight.
As to your question about Sustenon - I'm somewhat knowledgable about steroids and their individual profiles. Sus has very low toxicity to the liver. Matter of fact, most test-based injectible steroids are relatively mild on the liver. It's the pills you have to worry about.
I'm surprised your doc has you on Sus 250 every week. That's a lot of test for just hormone replacement therapy. There is some added risk for high blood pressure with testosterone, so watch out for that. How long have you been on Sus? I would eat healthy and get in some exercise while you're doing it, because it will make you eat a lot and you can gain a lot of weight.
I forgot to mention I am now on 6 Riba daily rather than the 4 daily of my previous tx and the extra meds have made quite a difference to the sx and to to my response. I'm currently UND and I was a previous null-responder to 24 weeks of tx. Also I was on a trial for a Polymerase Inhibitor (R7128). I believe there are trials for the same drug happening in Australia if you wanted to look into it.
Epi :)
Epi :)
Hi Steve,
I am a G3 also and begin my first tx in about 2 1/2 weeks. I as well will be taking 7 riba a day also. So maybe the stronger form is what you were missing last time and this time we will be close to starting and finishing together. May we both SVR!!
Sorry I cant answer the other question either but wanted you to know maybe your dosing is better this time.
Good luck
I am a G3 also and begin my first tx in about 2 1/2 weeks. I as well will be taking 7 riba a day also. So maybe the stronger form is what you were missing last time and this time we will be close to starting and finishing together. May we both SVR!!
Sorry I cant answer the other question either but wanted you to know maybe your dosing is better this time.
Good luck
Hey Steve, welcome, or perhaps I should say welcome back?! Can't help with your testosterone question but just wanted to say I'm in Auckland, NZ, so we're cuzzies across the ditch, I'm a G3a also and have 8 weeks left on my second tx, this time 48 weeks. I know how it feels to have to climb on the tx wagon again and just wanted to wish you all the best with your second approach. Good luck!
Epi :)
Epi :)
Hi steve welcome to the forum I.m G3 aswell did my second tx 2 months ago click my profil you see my info.
I don´t no about the Sustanon either try search testosterone in the right top corner of the side.
Seee ya.
ca
I don´t no about the Sustanon either try search testosterone in the right top corner of the side.
Seee ya.
ca
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