Hello Countless,
Your concerns are valid.
With your level of fibrosis, which is cirrhosis level your prognosis is not good. The 10 year mortality with SVR is under 10% and plateauing, whereas without SVR it is nearly 30% and still rising. That in an off itself is probably more than enough reason to treat.
From the professional point of view you need to be cured to work, so that is a reason to treat unless you want to change out of exposure prone procedures which may or may not be practical or desirable.
In terms of cure rate we know that the trial results always exagerate the success rates when compared to what we see in the real world. The VA did a study of over 4000 treatment naive patients taking Gilead branded Harvoni and despite the assertion from the ION trials that the success should have been 97% the VA (an independent umpire if you like) found that cure rates were 91-92%.
fixhepc.com/forum/experts-corner/1316-ha...va-study-n-4365.html
So the real failure rate is more like 9% than 3% in the easiest patients to treat when it's done on a large scale real world population. We see similar results with generics, and this is the worldwide experience. Still a 1:11 chance of failure is 10 chances of success, 1 of failure. Good odds.
The DAA drugs have now been given to 1 million in Egypt (Pharco generics) and 1 million in the rest of the world. If there were any common adverse effects we would know about them now. The experience here is that almost all people have very few issues either on treatment or after treatment. There have been over 2000 people here report their personal experience and there is no censorship to hide the truth.
A Freedom of Information request to the FDA 6 months or so ago turned up this list of adverse drug reactions:
fixhepc.com/forum/experts-corner/786-off...-effect-reports.html
20.8% (158/759) Headache
18.1% (137/759) Fatigue
5.9% (45/759) Insomnia
5.7% (43/759) Nausea
5.7% (43/759) Diarrhoea
3.7% (28/759) Rash
3.2% (24/759) Anxiety
2.8% (21/759) Vomiting
2.0% (15/759) Nasopharyngitis
[snip]
Which is a near perfect fit with the "gut feel" we see in the real world. So while some patients do get side effects these are mostly low grade and transient. We observe that for almost all drugs we give if a patient is having problems with that drug taking them off it allows for resolution over time. This certainly seems to be the case for DAAs.
But for me, ultimately I apply the mum test. If this patient was my mum what would I recommend? For you the reasons to treat are the professional implications of not treating, and your current advanced stage of fibrosis.
There will always be better drugs in the future. Pick any disease, at any time in history and you can see that's the case. While the new drugs may be better in terms of results we don't know until a large group has taken them just how well they work, and what, if any, long term issues, or unusual issues will happen. What we have now works well and is generally safe. The risks of you treating now are almost certainly minuscule compared to the risks of just waiting around - physical health risks, mental health risks, professional risks.
The decision to treat can be lonely and must sit comfortably with you, but if you were my mum.....