Weight and Drug Response

[Rockerforlife]

Just a simple question,when they say its better to be at a lower weight before starting TX,as this is proven to attaIn SVR at better rates....so if a person is 200 lbs and in good shape with no fat with a 25 BMI...as opposed to a person that is 175 and outta shape and obese...do ya think the 200 lb person would be  more likey to SVR ,even tho he is heavier...i guess we have to factor inthe fatty liver equatio too...AWWW...its all a c.rap shoot...i give up

[m_strings]

Oops:  Maybe you weren't talking about yourself in your initial post.  Whoever you were asking the question about: Do they have issues with IR and have a fatty liver?  Just curious.  That might make a difference in tx suggestions.  

[m_strings]

I might have missed this in one of your posts.  1.) Do you have any issues with IR? 2.) Did your hepatologist mention that you had a fatty liver?  

[m_strings]

Hey, Hijackers are people, too!  (And thanks for your permission & understanding.)

BTW: Has tx changed quite a bit since 05?  I know it wasn't that long ago, but I would imagine it must have improved some since then.  I'm wishing you the very best!  

[Rockerforlife]

Do all the jumping you want...MS Hijacker....:>)

[m_strings]

Thanks for pointing that out re: BMI calculator & muscle.  I didn't even read that.  And yes, we women are designed to have more fat.  Go Annie!  : )

[m_strings]

Re: Fatty liver.  It is supposed to be correlated to BMI, yet how do we explain those with 40+ BMI who do not have fatty liver?  Lots of unknowns.  Sure wish we had all the answers.  

Great Bird: Good points re: weight-based dosing.  I see there are some current trials that are working on trying to figure out the right dosage for BMI.    

The IR discussion is interesting and I REALLY appreciate the link to that previous discussion.  That does help clarify the IR issue.  That makes a lot of sense.  The studies, you would think, should then focus on IR rather than BMI, as BMI alone doesn't seem to quite fit. There may be other factors that often coincide with BMI, however, that are yet to be determined.  

As for me, I'm fairly certain I've had fasting glucose and insulin tests that have been well in the normal range.  I'll have to check my labs when I'm back in Illinois (Monday).  I usually eat a fairly low GI diet: Whole grains, fruits, veggies, nuts, legumes, etc.  I wonder if it's still possible to have blood sugar issues as I have had sx of hypoglycemia in the past.  I understand there is a five hour blood glucose test that can be given to more accurately determine blood sugar issues.  I'm not sure who does this or if it would be covered by insurance.  It would be good to find out more definitively.

Rocker: I'm sorry to tread on your thread.  I have interest in the same topic and it appears I'm posting a lot of my own stuff here.  Hope you don't mind me jumping in.  

[Trinity4]

Over weight -  no - control over that    
It should read not overweight, I do control that.

[Trinity4]

High ferritin prior to tx because of PCT.  3 months of weekly phlebotomy's with a 16 gauge needle.  Torture.  Control over that but I didn't want to do it.

Advanced liver disease -  No control

High GGT - no control  still in the 70's to date but AST and ALT good

Over weight -  no - control over that

IR -  not that I know of but if I did have it I could get it under control with meds & diet.

Fatty Liver -  no

Slow responder - yes,  SVR -  who knows?  

There ARE things we can control and things we can't control.  I'm addicted to cigs. Smoke 5 a day but I'm still addicted.  Can I give them up?  Yes.  Do I want to?  No.

So my point is it really doesn't matter if you can justify the good and the bad.  Bottom line is either you'll SVR or you won't.  Can't lose my grip worring about things I can't change but I chose not to change them I only have myself to blame.

[Rockerforlife]

Personally,I think the issue concerning weight,SVR and TX has more to do with the amount of fat in the liver ...

[annieCinMD]

I don't think that BMI calculation is carved in stone, and shouldn't be taken as such. It is particularly misleading if you are quite muscular (muscle is heavier than fat).  It's pretty much a guideline. From the link that m_strings posted: 'Highly trained athletes may have a high BMI because of increased muscularity rather than increased body fatness. ' That site explains the whole BMI pretty well. Women tend to have more fat than men at the same BMI (we're supposed to have more fat than men, period).

[Rockerforlife]

Moderate damage...stage 2....BX done in Fall 2005...this is my second round of tx....so im proberly still at that stage or maybe a tad lower,....God willing

[GreatBird]

I think one thing that used to happen with overweight treaters was if they were geno 2 or 3 they weren't being given weight-based dosages. I saw several people fail to clear here who vowed to lose weight before they tried again. I assume that now they would be given weight-based dosing, but I don't know for sure.

There also seems to be a limit with how much ribavirin they will prescribe. For instance, my dosing is 800mg daily. If I had a BMI of 44, I'd need double that amount for it to be proportional. To my knowledge, they don't go above 1400. If I was taller, I'd weigh more to get a BMI of 44 and I'd need even *more* ribavirin to have it proportionately weight based.

The other thing that I'm guessing is that extra weight goes with diabetes and the whole IR/interferon relationship seems to be one that not all doctors understand, i.e. it may be that underlying IR is really what the problem is . . .

CoWriter did a fantastic writeup of it here:
http://www.medhelp.org/user_journals/show/68011

[m_strings]

Marc: Thanks for the article.  Yes, I agree.  It is complicated.  As an aside, I found it interesting that this article indicated that baseline hepatitis C viral load can be considered a significant predictor of SVR.  I've read conflicting info about that as well.  

You commented:
"I'm guessing that your doctor was thinking that there are so many factors involved in likelihood of SVR that it is not right to think you can dramatically up your chances by altering one that is in your control."  

That's a really good point re: many factors that go into the likelihood of SVR.  Re: weight: It is more honest to admit that it is not within my control or I wouldn't have had a twenty+ year struggle with it.  But thanks for your optimism.  I just wanted to make that point, not to suggest that people who are overweight cannot lose weight.  Obviously it can be done.  But it's not as easy for everyone, and there are more factors than simply diet and exercise that come into play.  

Rocker: Did you mention what stage your liver is in?

Okay, I'm taking a break for a bit.  Be back soon.  

[m_strings]

Thanks Rock!  I appreciate it!  No vacuum cleaners or kitchen appliances either, okay?  I'll be happy to give you my Christmas wish list, if you'd like.  You'll have plenty of time to shop!  :)

I'll check out the link you listed.  Much appreciated.  

[Marc1955]

Here's the article I was reading recently that referred to BMI:

http://www.sciencedirect.com.monstera.cc.columbia.edu:2048/science?_ob=ArticleURL&_udi=B6WFX-4JR5FWG-W&_user=18704&_coverDate=04%2F30%2F2006&_rdoc=25&_fmt=high&_orig=browse&_srch=doc-info(%23toc%236806%232006%23998699995%23620899%23FLA%23display%23Volume)&_cdi=6806&_sort=d&_docanchor=&_ct=72&_acct=C000002018&_version=1&_urlVersion=0&_userid=18704&md5=4d2b588acfb4259c30b2a0928a286faf

Turns out I didn't have the findings exactly right. These things are so complicated. Here's the relevant part of the discussion:

"In the entire population, the presence of advanced fibrosis or cirrhosis (stages 3 or 4), age, BMI, triglyceride levels, GGT levels, baseline hepatitis C viremia (P < .001 each), body weight, glucose levels, ferritin levels (P < .01 each), body surface, cholesterol levels, alkaline phosphatase levels, aspartate transaminase levels, and platelets (P < .05) were significant predictors of SVR.

"Multivariate analysis showed that only GGT level (P < .001), age, cholesterol, baseline hepatitis C viremia (P < .01), and BMI (P < .05) can be considered as significant predictors of SVR."

I'm guessing that your doctor was thinking that there are so many factors involved in likelihood of SVR that it is not right to think you can dramatically up your chances by altering one that is in your control. Most, of course, are not in your control.

[m_strings]

Oh, found it!

High body mass index is an independent risk factor for nonresponse to antiviral treatment in chronic hepatitis C.
Bressler BL, Guindi M, Tomlinson G, Heathcote J.

Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

The aim of this study was to determine if body mass index (BMI) was an independent predictor of response to antiviral treatment in patients with chronic hepatitis C. A retrospective review was performed of all patients at a single center with chronic hepatitis C treated with antiviral medication from 1989 to 2000. A sustained response was defined as either negative hepatitis C virus (HCV) RNA by polymerase chain reaction and/or normal alanine aminotransferase (ALT) level (only in those treated before availability of HCV RNA testing) 6 months following completion of therapy. All patients were classified into one of 3 groups according to BMI (normal, 30 kg/m(2)). A total of 253 patients were treated with either interferon (IFN) monotherapy or IFN in combination with ribavirin. Patients were excluded if predetermined clinical characteristics were unavailable. Using logistic regression, and after adjusting for the examined variables (age, sex, history of alcohol consumption >50 g/d, cirrhosis on pretreatment biopsy, and BMI), likelihood ratio tests showed significant differences in response to treatment according to BMI group (P =.01), genotype (P <.01), and cirrhosis (P <.01). Those with genotypes 2 or 3 had an odds ratio (OR) for success of 11.7 compared with those with genotype 1, cirrhotic patients had an OR of 0.15 compared with noncirrhotic patients, and obese patients had an OR of 0.23 compared with normal and overweight patients. Hepatic steatosis was not an independent risk factor for response to antiviral treatment. In conclusion, obesity, only when defined as a BMI greater than 30 kg/m(2), is an independent (of genotype and cirrhosis) negative predictor of response to hepatitis C treatment.

Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12939590.

[Rockerforlife]

OK....i wont give you wegh scales as a gift


GOOD READING


http://www.natap.org/2003/dec/122903_9.htm

[m_strings]

Does HOMA include glucose test?  If so, I've had that done in January and had it done several years in a row.  It looked fine.  What other tests in the lab work make up the HOMA?  (Or is that the name of a specific test?)

BMI and TX research link, anyone?  Anyone?

[bajawoman]

Hey strings have you had your HOMA checked lately???

[m_strings]

Okay, watch it Rocker.  Enough about my weight!  :>)  That's more taboo than talking about age!  (But yes, I am over 5'.)  But it goes to show you that you shouldn't be overly concerned about your BMI re: tx, unless there is something you are not sharing with me.  Again, I am not a medical doctor, so your doctor's advice would take precedence.  

Do you have a link to the research re: BMI and Tx?

[Rockerforlife]

I hope your at least 5 feet tall....with a BMI at 44 your weight would be 225

[m_strings]

Yes, according to the CDC BMI calculator:
http://www.cdc.gov/healthyweight/assessing/bmi/

[Rockerforlife]

Your BMI  is 44 ??.....are you sure?..that seems high

[m_strings]

PS: Rocker, I certainly don't mean to go against any medical advice you receive from your hepatologist.

Could someone site the research here again so I could take a better look at it?