RVR and IR

[Upbeat]

Has anyone had RVR with Diabetes or IR?     After reading about how IR seems to interfere with the mechanism of interferon I wonder if RVR is out of the question if you have diabetes?    I have been trying to get info on slow responders, nil responders and relapsers to try and gage how much IR really plays in the outcome.

[FlGuy]

My BS numbers have been all over the place the past few years.  Problem is that treatment really messes with accurate fixing of the situation.  When I was on treatment AIC dropped to what would be about 'normal' (around 6) but went back up north of 7, even with SVR.  I am told that the 'favorable' readings on TX is due to the early death of red blood cells, thanks to the riba.  When the cells die young they cannot get a lot of glucose attached to them as they would in the normal life span of a red cell.  Post treatment back up to 7 ish.  Now on metformin and glimiprimide (bad spelling for both).  Come 11/19 I hope to be off both due religious diet and exercise for the last 4 months.  So, far looking OK with periodic glucose readings - but we'll see.  I have come to belive that post treatment and post HCV  with SVR has no bearing on blood sugar numbers and that I am IR and always will be.  Although it will not be resolved it can be controlled only through diet and exercise and it's a permanent lifesyle adjustment in order to be medication free.  I have been SVR long enough (I think) to have a repaired liver so I can't blame any BS problems on a bad liver. (But, there is no real way to find out anyway)

By the way, the reason that I got to UND in two weeks is because I pre-dosed riba and did double peg for the first four weeks of treatment.  Not exactly music to your ears, I expect.  

[Upbeat]

Wow thats great.  You are the first I heard of.  How well was you DM controled?  I mean what was you A1C numbers when starting treatment?

[FlGuy]

What I am saying is that I am IR (apparently continue to be to this day) but achieved undetected viral load after two weeks of treatment inspite of IR and DM.

[Upbeat]

Thanks
             It appears that IR is the main factor as a neg predictor for interferon treatment.  

[willing]

diabetes/IR and HCV are not a good combo since they seem to compound each other. However IR would not be expected to have any effect on PIs, which appears to be the case.  See AASLS abstract 805.

"No Impact of Insulin Resistance on Antiviral Efficacy of Telaprevir-based regimen in HCV Genotype 1 Treatment-Naive Patients: Subanalysis of C208 Study "

"Conclusions: In this retrospective analysis of G1 patients treated with TVR based regimen 1) BL HOMA was not predictive of virologic response; 2) SVR was associated with an improvement of HOMA. These results suggest that metabolic factors and insulin resistance do not have significant impact on treatment efficacy. These results warrant further confirmation. "

so adding a PI may be the best way to address the problem. The results from using insulin sensitizers seem less clear cut, see:

http://www.ncbi.nlm.nih.gov/pubmed/19919569
vs
http://www.ncbi.nlm.nih.gov/pubmed/18555553

[Upbeat]

Are you saying the IR was undetected after 2 week or viral load?   If the IR was undetected did you get RVR at week 4?

[FlGuy]

In was undetected after week two in second treatment. But, it required peg interferon.