My four week PCR results-comments welcome.

[HCA]

I recently posted that I had commenced re-treatment post relapse after 48 weeks treatment.
Previously I had been a three time non-responder.
Quite a few of you were kind enough to wish me well.
Geno 1a/1b.
Baseline RNA 805000 iu.
Four week result 415 i.u
Promising BUT spiralling hgb and lack of success with procrit has meant reducing riba to just 400mg per day for the time being.
My doctor (top man in the Hep C world) says that the riba build up in my system is so prolific that the low dose could be perfectly efficacious.
Another complication has been the developement of kidney dysfunction and a kidney biopsy.
A renal specialist is going to make a call as to whether the nephritis is caused by the hep or the treatment.If the latter I shall have to susoend treatment.
If anyone has input on either of the two clinical issues of low dose riba and the kidney problem I would be pleased to hear from you.

[Hepatitis Researcher]

Did you cross over the creatinine and urea values?
Can you give the units (mg/dL? or mMol/L?
Normal range for serum creatinine is .5 to 1.4 mg/dL, for BUN ( Blood Urea Nitrogen) it is up to 26 mg/dL.

[Hepatitis Researcher]

you probably have your serum creatinine values in umols. The 50-120umols are "normal range". So 117 would still be in that "normal range", but creatinine is not a very good measure of remaining glomerular filtration rate/ functional nephrons. Are you in Canada? They use these units, and Europe.

I assume from your response that there are no other renal diagnostic parameters available. Waiting for your biopsy results when you have it.

[jmjm530]

Your lower riba dosing may have to with your kidney function. In fact, in Sweeden, a group of researchers have developed a pharmokanetic (sp)? formula for riba dosing based primarily on kidney function as opposed to the weight-based dosing used here.

This forumla was in part developed by testing serum riba levels with high performance liquid chromatography (HPLC), a test that unfortunatly is not available in this country last time I checked, except in some research institutions. It was this test that the riba dosing was based on in that famous High Dose Riba Study where nine out of ten geno 1's (there were only ten in the study) achieved SVR.

Without HPLC testing, some might argue that we're in the dark regarding riba dosing -- especially for someone with an impaired liver as you may have. The Sweeds offer a second barometer -- crude by some of their off the record words -- which is dosing based on the level of anemia. In other words, the more anemic you become, the more riba is being circulated in your serum, etc.

You mentioned that you had quite a hemoglobin drop as well as some possible kidney issues, so perhaps that is why your doc has lowered your dose.

That said, are you on Procrit? I would think that would be a first step unless contraindicated because of your kidneys. Everyone in the Sweedish study was both on Procrit and Iron supplementation, but again, their dosing was quite high -- higher than any standards used in this country. I was actually trying to emulate the Sweedish study when I ended up in the ER at week 2-3. My approach needed a little tweaking :)

All the best,

-- Jim

[jmjm530]

If you google "ribavirin Lindahl" you will get more Lindahl than your bargained for :)

Here is their now famous 90% SVR pilot study: http://tinyurl.com/vase5

Don't have the links handy but a couple of other titles  to search for:

1) "Evidence that plasma concentration rather than dose per kilogram body weight predicts ribavirin-induced anemia"

2) "Dosage of Ribavirin in Patients with Hepatitis C Should be based on Renal Function: A Population Pharmacokinetic Study"

Then there is the study I can't find online that talks about serum riba levels correlating to anemia. I also believe one of their earlier studies talks about riba dosing in kidney impaired patients.

[Kalio1]

Thanks to you both for posting those links! Much appreciated by my tx addled brain.

[Kalio1]

I am sorry to hear you are dealing with kidney issues. Geez, can't anything just be easy?? I hope it can be resolved and soon. You have had so many challenges. Please keep us posted on what you find out. Hang in there.



citizen

I too have some of those same suspicions, that those who have to deal with anemia that requires Procrit seem to SVR more frequently. This is only from my observations here, but since my Hgb has never fallen below 10 and in fact this week is up to 12 makes me nervous. I hope it isn't a sign I will relapse again! Do you happen to have that study handy, the Swedish one?