Hi all,

Wondering if anyone out there has gotten pregnant while their partner is on interferon meds? I understand they can cause defects in baby but has anyone out there came out with a healthy baby? Im not pregnant but my hubs sis asks us and I really do not have an answer. I just tell her we cannot get pregnant while on therapy.

Thanks!

Carissy

Hello Carissy,

Unfortunately, we don't know enough about the long-term effects of paternal exposure to ribavirin.  It is believed that ribavirin accumulates in sperm in concentrations high enough to induce defects. In animal studies, ribavirin produced changes in sperm at varouis doses. These findings automatically triggered a black box warning.

There is a registry by Kendle International with an effort to accumulate data on woman exposed to ribavirin during pregnancy:

http://www.ribavirinpregnancyregistry.com/

Below is information from a report in PubMed:

"Although either ribavirin or interferon alpha could damage human embryos, no adverse effects have been described among offspring of women or men treated with combination therapy in the few human pregnancies where we know fetuses were exposed. No epidemiologic studies of paternal use of ribavirin alone, interferon alpha alone, or ribavirin–interferon alpha combination therapy have been published. Some case reports have described paternal exposure to ribavirin–interferon alpha within 6 months of conception.Out of seven men exposed to ribavirin–interferon alpha combination therapy (doses varied from 600 mg/d to 1200 mg/d) described by De Santis et al, six had fathered pregnancies within 6 months of discontinuing therapy. No offspring had congenital defects; one aborted spontaneously. Seven healthy babies were born (one patient had twins) with no complications during pregnancy or follow up, which ranged from 3 to 14 months after delivery. Conclusion: Four case reports showed no congenital malformations. Within the four reports, there were 12 healthy infants, five miscarriages, and two therapeutic abortions. Although ribavirin is a potential teratogen, there seems to be no immediate reason for terminating pregnancy when a father has been exposed to it. These pregnancies can be continued under close monitoring, for example, with level 2 ultrasound scans"

Here is an article for further information: 

http://www.intmedpress.com/Journal%20Management/display.cfm?viewinfo=3F74516309514A2F1B441B00401A641526542A285845171F074401400D31545E1A

0C11464F275232551A155E1602110648545E07104209330C52

Good luck to you and God Bless,

HI All

Today would have been my 3rd injection. I just completed my 2nd week labs this Wed.

The NP told me late Thursday I would have to stop the interferon (I can continue the Riba) until my WBC(?) or ANC (?) counts come up - they're at '78 or 780' - I'm not sure of the numbers. But she said my counts borderline.

They ordered neupogen - which may arrive next week - sometime - if I can afford the copay. I want to stay safe - but....

How will  the reduce dosage of peginterferon affect my chances of becoming UND?

Why can't I continue the shots and take the neupogen when it comes - since my counts are on the 'borderline' and not severe.

At times I'm a little foggy so I may have misinterpreted this - but last night I read a study (2003) on Janis about this - it doesn't' seem to be a good idea to interrupt the interferon - go on the Neupogen - wait until the counts come back up and then start the interferon again -  as it may reduce a person's chances for svr.

 All other labs are fine. I'm G1/stage 1/grade 4/18

thanks

Hi Muasi,

Yes, what you read about dose reduction and your reduced chances for SVR are correct.  However, since you are so early in your treatment, the interruption can be used to your advantage.  First, once you start the PEG Interferon again, that should be considered your Week 1 and continue on for 48 weeks.  Remaining on the ribavirin until you are approved for Neupogen will actually rev-up your immune system up so that when you do take your next injection, you will have a better viral response….you may feel more intense flu-like symptoms after that shot.

The ANC (absolute neutrophil count), is a measurement of this certain type of white blood cell in your circulating blood. These cells fight off infection and if the count gets too low (below 500), you are at risk. The interferon does reduce this count, but you have billions stored in your bone marrow.  The job of the Neupogen is to signal the bone marrow to release these neutrophills into the peripheral circulation, which will occur within 2 hours after the injection.  Your ANC count will increase (up to 10,000) and you’re all set to re-start the PEG interferon. 

For my patients, I usually prescribe 0.5 ml (150 ug.) 1 day before the PEG and another 150 ug. dose 2 days after.  This prevents the yo-yo effect on the ANC.

Good luck to you and keep us posted!

God Bless.

Donna Fanelli

Hi Donna,

I was wondering if you know if Ketorolace 10mg every 8 hours can do harm to someone with liver disease?

Thanks,

Listmaker

Hi Listmaker,

Ketorlac (brand name Toradol) is a strong NSAID.  It negatively interacts with  some medications and should not be taken with others. Short term, it is relatively safe for the liver.  It is more damaging to the lining of the stomach and could result in a bleeding ulcer.

It should not be used for more than 5 days and you can read more about it on this link:

http://www.migraines.org/treatment/pro_tora.htm

Good luck and God Bless.

Donna Fanelli

Hey everyone, I'm a 2 1/2 yr. transplant.  my problems stem from blockages or strictures of my ducts. i cannot go but about six months before needing a procedure to open these blockages up. now i'm at the point where i can onlt have the prt done. has anyone advice on what i could do. my transplant was done at music in Charleston, sc but i am more than willing to travel to get some decent care and answers.  needless to say, i'm not a big fan of the radiology dept. there.  you are just another # walking through, and all of them act like primma donnas. the radiologists and liver transplant team don't seem to work in unison. any advice would be greatly appreciated. thanks in advance.

Hi Tom,

I hear your frustration. 

Your situation is not uncommon in light of a transplant because there was an insult high up in the bile duct close to the liver. Blood flow to the bile ducts around the liver is diminished resulting in strictures. Repairing the strictures is very complex.  Finding a segment of normal bile duct is often extremely difficult because of associated injury to their blood vessels post transplant.  I assume this is why only one port can be done at a time.

You need to bring these concerns up to your clinician. Don't leave the office until you have an understanding as to why only one port can be done at a time. This is your right and the clinician’s duty!

Stay well and God Bless

Donna

Hi Donna,

Could you explain why 5 yrs. ago, I was told that my genotpe was 3a but now I am told it's 1a. How come the tests for genotypes doesn't pick up any/all types that are present. How do I know if 2 genotypes are all i have and what does it mean?

Thanks, Cindy

Hi Cindy,

It is possible to be infected with multiple genotypes, meaning you were exposed to both viruses at different times. Were you treated 5 years ago?  If you cleared at that time,  it's likely you were re-infected. 

There is a slight possibility that the the older result may not have been performed by the more advanced testing assay that's used today.

You should be evaluated closely and definately consider treatment.

God Bless,

Donna Fanelli

HI Donna,

I asked this in the general "concerns" forum and was referred here as no one was really sure.

Undetermined Genotype result was from test = Hepatitis C Viral Genotype, completed about 10 days ago.

Good Afternoon,

This is my first post and have been recently been diagnoised with HCV.  I am going through the initial blood work and was told that my Genotype was "undetermined"

I was able to find on article that stated if Genotype can not be determined, will be treated as 1.

Any ideas on this?

Hi HB,

Yes, an undetermined genotype will be treated as a genotype 1, just to assure the best outcome.

You may want to ask your clinician to repeat it and send the specimen to another lab.  Over the past few years, more advanced diagnostic tools have been able to better identify the genotype and you want to make sure the most advanced testing was performed on yours.

In any event, you have about a 70% chance it’s a genotyye 1 and in addition to genotype, there are other factors that should be looked at to guide the treatment regimen.

God Bless,

Donna Fanelli

Hi Donna,

I am HCV geno 1B on week 28 or 29 of treatment. I have been UD since week 12. I also probably have Cryoglobulinemia although the GI never confirmed with test, he just says yeah probably.

I was originally diagnosed with Rhuematoid Arthritis due to a high RH test result. I also had pain in most of my joints and swellings on knees and my knuckles. I was sent to a Rhuematologist who said the swellings I had on my joints were not in the right place for RH and he did test for HCV that came back positive. I was sent to GI for HCV. Tested for HCV and started on Treatment of 180mcg pegasys and 1200mg ribaviron. Ribaviron was decreased to 1000mg around week 13 or 14 due to breathing issues. I am UD and have been since week 12. Since about week 15 of treatment I have had very little joint pain and have started to resume some of my preillness activities although I still require at least 12 hours of sleep a night. This is true except for Wednesday (day after shot) and the 3 days before my period starts. During those days I experience extreme fatigue(20-22 hours of sleeping) and extreme discomfort. My belly bloats up so badly it sticks out. I get recurrent and extreme diahrea. The swellings on my knees increase in size. All my joints ache, I get nauseated and I generally feel like I have the flu. By the second day of my period I seem to be back to normal again. The day after shot I understand and expect. But, would either HCV which is currently UD or treatment cause the period week issues or could it actually be something different? How much does treatment and/or HCV really effect womens cycles?

Thanks for any info you have on this issue.

Hi Bette,

It sounds like you’re doing great!  So often treatment makes underlying RA symptoms worse.  In your case, your joint pains were related to viral infection and have improved.  To answer your question, yes combination therapy will cause menstrual irregularities.  It’s not uncommon to have menses to cease altogether later on in treatment.  The body is compensating for the drop in hemoglobin caused by the ribavirin and sparing you additional blood loss.  The hormones are out of sync and will cause the bloating and swelling.

Bring this up to your clinician and ask if a very mild diuretic taken 1 day before the anticipated day of your next menses would help.  Something like hydrochlorothiazide 12.5 mg may do the trick.

Stay well and God Bless.

Donna Fanelli

Donna - My question is this.  I had a 4 week PCR run.  My viral load had gone from 1,050,000 to 139,000.  My dr said I was a "slow responder" and that the 4 week viral load was the new standard.  I had hoped that I had misunderstood - but since then I've done major reading.  One study jumped out at me (most agreed with the 4 week being the new standard :o( ) that said for geno type 1's, at 4 weeks, if your viral load is over 100,000, you have less than a 3% chance of getting SVR.  Do you have any more information on this?  I'm going to stick it out for the 12 week viral load (so many encouraging words from this website), but if my chances really are less than 3%....I am contemplating waiting for the new meds or at least a clinical trial.  Thanks!  Dottie

Hi Dottie

The buzz  word for the past 18 months or so has been RVR, Rapid Viral Response, meaning the viral count is undetectable at Week 4.  I have routinely checked a PCR at Week 4 for awhile and now it's pretty much the standard.  Each clinician uses the information differently.  Some studies suggest treatment duration can be reduced, others predict an increased SVR.  The bottom line, a 4 Week PCR is a guide.  Yes it would be nice if you cleared at this point, but there is no data to suggest you won't achieve SVR.  The study you're referring to looked at persons with more severe disease and I believe the treatment regimen was sub-optimal.

The 12 Week PCR provides a clearer picture, because there is more literature looking at the prognostic implications.  I applaud you for sticking it out until then.  If you are 'almost undetectable' at week 12, continue for another 6 weeks. Sometimes tweaking the regimen can yield better results.   Assuming you clear at Week 18, you should stay on treatment for a minimum of an additional 36 weeks, preferably 42 weeks more.  Again, this is in light of minimal side effects and the ability to remain on the maximum dose with minimal risk.  It is imperative that you don't miss a dose of ribavirin, and don't delay taking your shot…even a couple of hours can make a big difference with weekly Peg- Intron or daily Infergen.  Drink plenty of water, exercise and eat a diet high in complex carbohydrates and low in fat.  Take Omega-3 fish oil capsules and you will do fine.  Good luck to you.

Keep in touch and God Bless,

Donna Fanelli

From jenibjones  
contradicting information. Those exposed to 'mucosa' from that of known infected person should be tested??? I read that kissing is not a major risk factor but the mucosa is eyes and mouth. Now...tell me why that is not a threat, kissing some one with possible gum disease is a threat? There are levels of gingivitis and periodontal disease, help me under stand. My common sense tells me unless you have excellent oral care...you could be a higher risk person to give the disease to another...for the record my mouth is very healthy.
thanks..
may questions left....

Jenibjones,

Hepatitis C is a bloodborne disease; the virus is transmitted by infected blood.  HCV is not transmitted via any other body fluids unless those body fluids have been contaminated with blood. Gingivitis, an inflammation of the gum tissue surrounding the teeth, often results in bleeding gums because the tiny blood vessels rupture as a result of the inflammation. For the virus to be transmitted, the infected blood must come in contact with an open sore or wound and be carried through the circulation.  Unless the kissing results in trauma, the risk of transmission is extremely low.

I hope this helps. God Bless,

Donna Fanelli