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freepdfhosting.com/022166be38.pdf

Interesting article about RAVs and Harvoni treatment with the bottom line being longer works better with RAVs and in people who are treatment experienced. There is also the suggestion of adding a 3rd DAA.

Hi Dr. Freeman,

thank you for this article.
I have to admit that the information about RAS in this article is somehow puzzling for me, yet having been through the article, my understanding is that for a GT1 patient who relapsed after the SOF/LED treatment for 12 weeks, the alternatives are:
- either retreat with SOF/LED for 24 weeks (which seems to lead to almost 100% cure rate) // however this information is somehow contrasting the information about re-treatment options presented here freepdfhosting.com/b3d39c5e48.pdf on page 14 - Ch. "Re-treatment Strategies after Failure of IFN-Free Treatment"
- either retreat with SOF/LED+ a 3rd DAA ( which one might this be? VEL?, VOX?, DAC? ) for 12 or 24 weeks.

Just an idea: would it be perhaps recommended and financially feasible, to treat GT1 patients right from the beginning with a combination of 3 generic DAAs? I would imagine that perhaps adding another ~100$ (that's just an imaginary cost ) to the generic treatment costs, the risk of relapse will be very very low, so a GT1 patient who might relapse (if treated with SOF/LED only) could save some time, money and stress by not having to retreat.

Cheers,
RHF

I have little doubt that we will move to 3 drug therapy for HCV treatment targeting NS3/4A, NS5A, and NS5B in the near future. Viekira Pak already does that but is hampered by a weak NS5B.

All of Gilead's Sofosbuvir + Velpatasvir + GS-9857; QUARTZ-1 V-pak + Sof; C-SWIFT Zepatier + Sof use this strategy which is simply borrowed from the HIV experience with HAART - Highly Active Antiretroviral Therapy with 3 or 4 drug combinations.

Maybe ABT-493 + ABT-530 are strong enough without Sof but it's hard to imagine they would not be better again, maybe even perfect with Sof.