DAAs as prophylaxis?

[Chester]

Can or could the DAAs be used as prophylactics? In terms of secondary and tertiary prevention. I’m thinking, for instance, in the case of some G3s given the cure rates are not yet quite as high as other genotypes. If they fail to clear the virus, could they be kept on the drugs either indefinitely or for periods beyond the current treatment periods of 12 – 24 weeks to keep the disease at bay until more effective drugs arrive. IOW could DAAs be used like current HIV meds in hard to treat cases.

Or does resistance or some other problem prevent this?

[Dr James]

There is a discussion about resistance here http://fixhepc.com/forum/experts-corner/164-resistance-and-treatment-failure-mechanisms.html

Yes you could do that if the price was affordable.

Yes you would expect to select for resistance to these agents, but this may not be a major issue for a variety of reasons.

Personally I would suggest retreatment with a “longer and stronger” approach adding a third DAA and doubling the original treatment duration.

Sofosbuvir resistance has already been seen http://www.medscape.com/viewarticle/818806_5

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YMMV

[Chester]

Hmm. I am yet to fully wrap my head around the resistance thing. Have read all the stuff on here and more. Hep c nurse said not to fuss about it much. If it comes back we’ll hit it again harder. Seems consistent with what you’ve said above. So resistance is an issue but not a big issue? Maybe this was all said in terms of the checklist she assessed my chances of SVR12 against (early responder, 1b, treatment naïve, minimal or no cirrhosis).

I’m not worried. I’ve felt for the last week it’s all gone and I choose to believe it’s going to stay that way unless something happens to make me think otherwise. But in terms of breathing space for sicker people, it will be good if the current drugs have some use to keep more serious disease at bay until even better cures come along.

[Author]

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