Hi guys and girls,

Sick Boy here.

It's been a while since I last checked in. I am the guy who was really
ambivalent about starting the Tx a few months ago. <g> Well, now I'm
at Week 18, with 6 more to go (according to my doctor)...genotype 3a.

While I'm at it, let me go over the key points of my Tx...LFT's
normalised at Week 2, according to my first blood test, and have been
normal since then (which feels great, since ALT and AST had been
around 100/200, respectively, pretty much since I got infected). All
blood counts are normal, except for very slightly lowered
RBC/hemoglobin, but I'm feeling fine on that front, and Dr. said I
didn't have to take Procrit if I didn't want to (still have it in my
fridge).

Viral load was undetectable (down from 2.7 million), at Week 4 test,
according to the sensitive test that detects >5 IU/ml, and now as I
found out by calling, at Week 12, as well. I guess that's the good
news.

Side effects--nothing major, at least compared to the hell quite a few
people describe going through. Changed hair texture, not as thick as
used to be--small things like that. But with 6 weeks left, it's more
of a mental thing...some depression, can't get focused or motivated,
"I don't give a f.ck" sort of attitude. But it's difficult to say if
it's the Tx, or the fact that I'm aware about it. It's gotten easier
since the beginning, when I didn't know what to expect. Oh, I still do
get a slight fever the next day after the Peg-Intron shot, joint
aches, feeling flu-like, headache...but again, rather minor, and it's
gone after a day, anyway.

Now, onto what I wanted to discuss.
I was thinking/reading about duration of Tx. I see some people
(Russian and Guy, at a first glance--I've not been keeping up lately,
sorry) who may extend, or shorten their duration of staying on the
meds, and they have their reasons or logic, or Dr's advice, for their
decisions. Some doctors think that longer is better, which can
actually be really damaging (I'll get to that in a minute).

Does anyone consider the 24/48/72 weeks model a bit too rigid? It
seems like arbitrary durations that insurance and drug companies have
come up with, for standardisation. I'm reading an excellent book by
Dr. Melissa Palmer, "Hepatitis and Liver Disease", and among other
great points, she stresses individual approach to Tx method and
length.

In my case, I've been considering taking Peg-Intron for an extra
couple of weeks, after Week 24, after talking to the liver Dr. But not
Ribavirin--I'll explain below. I've heard of liver Dr's and/or
patients extenting their Tx duration "just to stay on the safe side".
I wonder just how much sense it makes from the medical point of
view--not just intuitive "more is better" approach. In fact, taking
ribavirin for longer than necessary may actually turn a Tx case that's
going extremely well into a failure.

Let me explain.
I have a friend who's a pharmacologist, among other things, and
although viruses is not his direct field, he knows a lot about viral
stuff (esp. HCV), and related subjects, and has a lot of direct
experience in academic research, etc. (he teaches at a major
university) Of course, don't take his words for gospel, but below is
some possibly relevant, IMHO, stuff that he wrote.

I just want to get some opinions on this, with regard to the length of
Tx and Ribavirin's indirect supression of immune system when taken for
too long, which allows the "sleeping" HCV to take advange of the
compromised immune system and replicate, quickly returning to status
quo. Even with undetectable VL, HCV is not truly "gone", it seems, but
such very low levels of the virus apparently aren't a problem for the
immune system/WBC. Well, read on...I don't know if anyone will learn
something new, but if this is true, then I may take my Ribavirin for
as long as prescribed, and Peg-Intron possibly a bit longer.

[Btw, INF here means PEG-interferon, unless otherwise stated]

*****START***********
I know a friend whose Hep C returned because his Internal
Medicine quack kept him on IFN/Ribavirin too long and although he
was completely viral RNA free at 6 months, eventually the Ribavirin
caused bone marrow suppression and as a result of the low neutrophil
count, the Hep C virus "returned."  If he had stopped the IFN/
Ribavirin at the 6 month mark or at least stopped the Ribavirin, he
would very likely not have retested positive again at this point.

(Hepatitis C Virus {HCV} is an RNA virus which uses the enzyme Reverse
Transcriptase to turn RNA into DNA. The DNA then intercalates into the
hepatocytes, and even when you have a zero viral load and no viral RNA
present, there will always be viral DNA around in some of your
hepatocytes, just waiting for an opportunity to replicate, such as a
low White Cell Count or a compromised immune system.)

The sooner you have treatment after infection, the more likely the
current treatment modality (Interferon {IFN} and ribavirin) will work.
The longer you wait, the less chance of it working and you remaining
viral free after five years. Within the next 3 years, many new drugs
will be available to treat Hepatitis C, particularly protease
inhibitors, which are much easier to tolerate than the IFN/ribavirin
combo therapy. Some people have very little trouble with IFN and
ribavirin, but more often than not, the treatment is difficult.

If you have a history of severe depression, you may want to wait a few
year before getting treatment because  IFN (Interferon) and ribavirin,
can cause very severe depression (the IFN causes the depression.)
There are different versions of IFN available from daily, to 3 times a
week (Roferon) to weekly (Pegylated ) injections of IFN with bid
(twice a day) doses of ribavirin. The fewer times a week you have to
take the IFN, the less difficulty you will likely have with the
treatment.

IFN by itself is not that effective without ribavirin initially, but
after 6 months, if you have no viral load, you may want to consider
stopping the ribavirin to prevent neutropenia (low white blood cell
count)  and anemia (low red blood cell count). The other option is to
use medications to boost the number of white blood cells and red blood
cells. A low white blood cell count can cause the virus to come out of
the liver cells (hepatocytes) and cause a return to chronic hep C (as
I mentioned about a friend of mine who was treated by an Internal
Medicine doctor because his HMO would not let him see a hepatologist.)
A low red cell count can make you tired easily with any activity.

If you have a low absolute hematocrit (meaning it is not just from
being dehydrated like a low relative hematocrit, you should take
Procrit or Epogen if you can, and you should get a CBC to see if you
have neutropenia (the test is called ANC or Absolute Neutrophil
Count)  or  leukopenia (this test is called TLC for Total Leukocyte
Count). If you do have low white cell counts , there are several drugs
available for that now called Neulasta, Neupogen and Granocyte, or
another class of drug called Leucomax.. Again, you can prevent this
sometimes by remaining only on the IFN and stopping ribavirin (with
your doctor's advice only) if you have one of the genotypes that
requires more than 6 months of treatment.

If your virus comes back after a successful treatment, you are more
likely to get anemia and neutropenia sooner on the second go around
with IFN and ribavirin.

Your sleep is very likely to be disturbed during the treatment with
IFN. It seems to depress dreaming and this may be one of the reasons
it is so likely to cause depression. When you stop the IFN treatment,
people often report that they begin dreaming immediately upon falling
asleep and when they wake up they seem to be in the middle of a dream
for about 3-4 weeks after treatment ends, suggesting that dreaming is
almost completely stopped.
*********FINISH**********

Sorry it's a bit disjointed, but I cut out irrelevant material. Also,
I included the last paragraph because I thought it was an interesting
theory about dreams as a necessary protection against depression. I
actually have dreams on Peg-Intron.

I'll stop ranting, because I don't want to lose every last person
reading this, and really hope to hear what you guys have to say about
the central idea I'm trying to express. Am I correct in assuming that
the "longer Tx is better" approach is common among doctors and
patients of HepC?

Finally, thank you for all the great wishes...I was really
apprehensive waiting for the 12-week viral load results. Woohoo!
Cheers,