Hep C Discussion Forum

pl1952 · Senior Member

RE: Results of 2 week bloodwork - Few Questions

Cinnamon Girl · Guru

Hi pl1952, I`m also quite surprised that your hubby`s doctor wants to reduce his riba dose with such a good Hb level. And while he might have had decades of experience with older and well established treatment protocols, Sovaldi/Olysio is brand new drug combo and has a much shorter duration, so I would be cautious about accepting a dose reduction just yet. And especially as Malcolm pointed out, considering that your hubby has cirrhosis and wants the very best chance of success this time round. Just my opinion though!

Anyway it`s fantastic to see hubby`s viral load coming down so fast, you both must be delighted with this result, congratulations! smile

mallani · Guru

Hi pl1952,

I'm more cautious with cirrhotics. Hubby is only doing a 12 week course, so there's no way I would reduce Riba with a Hb of 13.5. I agree Riba is only for 'insurance', but cirrhotics need all the help they can get. Cheers.

pl1952 · Senior Member

Hi Tig,

Yes...seems the protocols are different with the different treatments. I just got this email:

"It's okay to lower the ribavirin. That would have been my next move if his hemoglobin was lower next time, but Dr. XXXX has been doing this for decades. I would lower his ribavirin. It will be okay. The studies seem to suggest that being on full dose ribavirin in the beginning of treatment seems to be the most important thing. Going down on the dose due to side effect doesn't seem to do anything in terms of changing the outcome. I think it's fine to go down on the ribavirin in short."

So happy Tig!!! Things are coming along really good!

Tig · Admin

Hello,

I agree that the Hgb isn't that low. I maintained a full 1200mg dose for 28 weeks with a value of 9. I do want to point out though that studies and reports dealing with the Riba dose for people taking the Sovaldi/Olysio combo indicate they have found little impact on SVR rates because of a moderate dose reduction. The success rate of that combo isn't affected nearly as much as it is when the same reduction is compared to people on an interferon based protocol. I'm seeing more utilization of Ribavirin dose reductions to control Hgb levels when Sovaldi is the backbone drug in use. So, after all of my rambling, I would tell your husband not to worry much about the dose reduction. Many people are being prescribed this combo without Riba and are achieving SVR just fine. While I don't think his Hgb is low enough to warrant a dose reduction, I would follow the doctors order and discuss it in more detail at his next appointment. He may feel a bit stronger as a result. It all looks good to me. You're both doing great!!! Keep it up and good luck to you both!

Tig

pl1952 · Senior Member

Hi Wayne! Was hoping to hear from you...I just did some searches here for low hemoglobin and I agree, that seems overly cautious indeed. I've also read a lot about not trying to reduce the riba dose. He feels good right now and he said he's not reducing the riba. I also emailed for the ALT/AST levels too to compare. Thanks Wayne!

OldenSlow · Senior Member

Hiya. That VL is looking great! Betcha he's clear two weeks from now. That 2nd email sure looks overly cautious re the Hb. He's still in normal range. Don't understand that one, but not his doctor, either. wink

wayne

pl1952 · Senior Member

Hi Guys, Well, we got back some preliminary info on the 2 week bloodwork my husband had done yesterday. I didn't expect to hear back so soon. Thought I would paste what was told to him and hear what you guys thought. We got two emails back which contradict the part about the hemoglobin. Here's the first:

"Labs look okay. Your hemoglobin (which is a reflection of his red blood cell count) went down to 13.5, from 16.3 a few months ago. This is an expected side effect of the ribavirin. We'll just watch it for now.

Also your bilirubin number is slightly up. But there are two different kinds of bilirubin and the type of bilirubin that you have elevated is the indirect bilirubin make me think that you have a benign condition called Gilbert's condition, which is fancy talk that you just make extra indirect bilirubin. The condition has never bothered you and should never bother you. However, your indirect bilirubin may go up on therapy with the simeprevir, because we've seen that drug elevate this particular lab value in folk's with Gilbert's condition. We don't worry much about it and it can get as high as 7 or 8 while the patient is on simeprevir. Your bilirubin number is only 2.4. Again, it's just something that we'll keep an eye on.

Okay. Let's get to the GOOD NEWS. Your Hepatitis C viral load went down to 394. That is down from 7 million in late February. That's a terrific drop. We're heading in the right direction. I suspect that the next lab draw two weeks from now will show that you are close to undetectable or completely undetectable. Regardless of the numbers,you'll need to take the medications for the full 12 weeks."

NOW, here's the other email from the nurse:

"Your hemoglobin has dropped quite a bit though, so Dr. XXXX would like you to take 4 pills of ribavirin instead of 5 daily.
This is to stabilize the hemoglobin You may feel fatigued, and short of breath if any of these symptoms become severe please contact the office and we will get you in sooner to see the doctor."

My husband feels terrific and doesn't want to drop the riba and responded so. Would love to hear your thoughts, anyone?

Thanks! We're so excited about the viral load drop!!!

Hep C Discussion Forum

Legal Disclaimer: