The purpose of this tool is to provide a simple user interface to navigate the upcoming Australian HCV treatment Guidelines which are by necessity limited to dealing with the PBS listed medications Sofosbuvir, Ledipasvir, Daclatasvir, Ribavirin, Viekira Pak, and Simeprevir with Interferon.
The intention is to also support the AASLD and EASL guidelines which have a wider scope.
I don't think the aim is to provide all permutations in the tool GAJ (ie some permutations may have same outcome) - so much as we be sure that the critical DAA components in each permutation which would produce or require a reframing / diversion in the decision trees are accounted for - Unless in the end, to achieve this, it does require all permutations hope Im making sense archer.
Fem. Gen 1a.18.4 kPa. IL28b - CT. Cirrhosis 4B/c. MELD 11. Portal Hypertension. Ascites. Varices. (Gr.3). post surgical Coma 2011- Tx denied. 15/09 - INR 1.2 platelets 58 (150-450) albumin 32 (35-50) bilirubin 40 (2-20) ALT 183 (0-45) AST 281(0-41) GGT 39(0-45). Liver lesions AFP 16 <8.
I agree that more options for previous treatment might be useful.
Some components of previous treatments may affect the recommendation due to resistance.
I was unsuccessfully treated with un-pegylated interferon alone in 1997.
GT1 F4 compensated, I/F non-responder 1997
@2015-11-06 VL 3.5 x 10^6, started Twinvir
@2016-01-29 started 2nd 12 weeks of Twinvir
@2016-03-01 ALT=42 AST=42, other LFT in normal range
I agree that some variations may (probably will?) give the same outcome.
But using me as an example which past treatment fail should be selected? Interferon/riba or NS3/4/5? I had both in trial but wonder whether the outcome from both choices could be the same? Admittedly mine would be a small subset. And in Tim's case possibly Inferferon/Riba may be considered close enough?
........but what about the case of someone who failed Harvoni (branded or generic), should the selection be for failing Sofosbuvir Xwks or failing NS3/4/5? How would that decision be arrived at? And would the outcome be the same for either?
<edit> Ouch Tim, that would be 3 jabs per week!
G3a since '78 - Dx '12 - F4 (2xHCC)
24wk Tx - PEG/Riba/Dac 2013 relapsed
24wk Tx - Generic Sof/Dac/Riba 2015/16 relapsed
16wk Tx - 12/01/17 -> 03/05/17 NS3/NS5a + Generic Sof
SVR7 - 22/06/17 UND
SRV12 - 27/07/17 UND
SVR24 - 26/10/17 UND