Only 7″ diff LG. you would almost be able to cry on my shoulder when the Riba gets to you.But 12000 miles might make it difficult.

Emilio,if you will pardon me butting in.I am in much the same quandary about extending as you .Our profiles are not dissimilar.I don’t just want to be in the 92+-% svr catergory,I want to be in the 100%.The use of Ribavirin,which apparently only adds about 5% to the equation is largely governed by conventional costs of the new DAA”s.At $100,000 for 12 wks adding an El Cheepo like Ribavirin (to hell with the side effects) that could save some govt agency forking out another $100,000 for a 24wk treatment makes economic sense.However,with the much cheaper generics, the landscape changes radically ,and this is not reflected in the various “How to treat” etc advisories,and the You-tube videos I have been watching.i am hoping that in the up and coming AASLD conference that is happening in the middle of November some definitive Data will be presented,particularly from Japan where sof-dac regimes have been widely used for some time.
I would very much like to keep in touch with you.

Hi All
I may be kind of in the same boat
I’m not up with the ‘lingo’ as I’ve pretty much ignored my hep for more than 10 years
i did the Interferon/ Ribavarin 12 years ago.
At the time i had a ‘difficult to cure strain’ (we assume is G1)
And significant liver damage (biopsy) – at the time it was a 3 and cirrhosis was 4
i feel a bit sick when i think of the damage done in the ensuing 12 years – i have only myself to blame of course

3 years ago my VL was 5 million+ (updated results coming)
My exact genotype results will be confirmed within a month as well
But a fibroscan is not booked until late January

I’ve just bought my first 12 weeks of sof/ dac and should be here soon
To avoid disappointment, I’m going to order another 12 weeks soon as I don’t want to leave anything to chance
I’m wondering if I should order some Ribavarin as well, just in case
Reason being, if, say, at 12 weeks I still show some viral load, I would prefer to hit it with everything i can
Having used it before, I’m wondering if it will do anything – but I’d even be happy with an increase of 2% chance of cure

I’m actually very worried about the state of my liver
I thought you would have symptoms if cirrhotic, but this seems incorrect
So I think it best to assume the worst and hit it with everything I can

The thing I am curious about in Hamiltons tx is this.Normally with his profile he would have the option of 12wks sof led riba or 24wks sof led.
The first option would be the one he would normally be steered to because the discomfort he might experience on 12 wks el cheepo riba is considered less than the discomfort of someone parting out an extra $100,000 for him to go on a 24 wk sof led regime without the riba.The question I have is that after 12wks sof led riba,is there an advantage in continuing with another 12wks sof led on its own without the riba .If any kind of resistance has appeared would the extra 12wks of sof led on its own make any difference.However,in this case he is presumably paying for his own tx so costs don’t enter into the equation.I can’t find any answers to this in the literature available.Maybe there just isn’t the data out there at the moment to answer this question.Maybe we could invite Dr Freeman to venture an opinion,although etiquette may prevent him commenting on another medicos advice.

In SIRIUS, a double-blind placebo-controlled French study, patients with cirrhosis who did not respond to PEG-IFN and RBV plus telaprevir or boceprevir, were randomized to receive placebo for 12 weeks followed by ledipasvir/sofosbuvir plus RBV for 12 weeks or ledipasvir/sofosbuvir plus placebo for 24 weeks. The SVR rate was similar in each group, 74 of 77 (96%) in the group that received ledipasvir/sofosbuvir plus RBV for 12 weeks (3 patients with relapse) and 75 of 77 (97%) in the group that received ledipasvir/sofosbuvir for 24 weeks (2 patients with relapse). This observation was further supported by a meta-analysis of treatment-naive and -experienced patients with cirrhosis who were treated with ledipasvir/sofosbuvir in phase II and III studies (including the SIRIUS study). In this analysis, ledipasvir/sofosbuvir for 12 weeks was inferior to ledipasvir/sofosbuvir for 24 weeks and ledipasvir/sofosbuvir plus RBV for 12 weeks; no difference in SVR was detected between the latter 2 groups. Safety and tolerability were similar in each group, and with the exception of anemia, reported adverse events did not differ substantially between patients treated with or without RBV. (Bourliere, 2014a); (Bourliere, 2014b)

Ledipasvir/sofosbuvir has been evaluated in patients with and without cirrhosis in whom prior treatment with PEG-IFN and RBV, with or without HCV protease inhibitors (telaprevir or boceprevir), failed. In the ION-2 study, patients who had not responded to prior PEG-IFN and RBV were treated with ledipasvir/sofosbuvir. This regimen was given for 12 weeks or 24 weeks, with or without RBV. In the population without cirrhosis, the overall response rate was 98% (95% confidence interval [CI], 96%-99%). Specifically, in patients without cirrhosis who did not respond to PEG-IFN and RBV, 33 of 35 (94%) achieved an SVR after treatment with ledipasvir/sofosbuvir alone, and 38 of 38 (100%) patients achieved SVR after treatment with ledipasvir/sofosbuvir and RBV. (Afdhal, 2014b) This regimen was well tolerated in all groups, with no serious adverse events reported in the 12-week regimen with or without RBV.In the population with cirrhosis, patients treated for 24 weeks had higher SVR rates than those treated for 12 weeks, supporting the recommendation that HCV treatment–experienced patients with cirrhosis receive 24 weeks of treatment without RBV.

..hope this helps

I think it’s a great discussion Hamilton and Miko we’re all learning this new DAA landscape including Dr F. Subsequent to this the first wave of generic uptakers Im sure we’ll see a range of tx options being tailored to genotype, weight and damage. I wouldnt rule out double dosing if my tx journey doesnt go to plan, or adding plus 12 and or leading out with riba. I will do what i have to in spite of what the experts know. I could live on this shit if needed, sure beats dying of a liver that’s transformed into a wall nut. I guess my point is that while we’re all tx’ng according to plan stock standard tx is okay. But all bets are off if the shit hits the fan.

I recall on my previous tx i had to present at a forum in melbourne. I did so with a neutrophil count of 0.2 and haemo of 9 due to overdosing on the white and red cell assassins. Anyway bla bla sorry peeps Em

Hey DT, I know you will tolerate the DAAs well. As Ive said many times this is a cake walk for me personally. And I say this with the deepest respect to those few are suffering from tx sides. Its a personal journey and everyone is different.

I believe some people could tolerate 800 sof and 120 dac with very few sides for 12 weeks and could be an option for harder to treats rather than the 24 standard. I definitely have. considered slipping 4 in rather than 2 lol. Particularly when i know that lightweights on here are dosing the same dose as me at 75kg.

Also leading in and/or out with riba and tben there is the tappering discussion. Oh DT weve been shufflimg these forums for way too long. Lets get this done. Em

Thanks for the support emelio.I think there are quite a number on this forum wks into various tx;s who will be in a quandary when the 12wks runs out.It’s like you are dragging around a ball and chain for 12 wks and at the end a guy hands you a revolver with 20 chambers and shows the key to the ball and chain.He waves the key and tells you that only one chamber has a bullet in it.Put that to your head and pull the trigger,You have a 95% chance of surviving.If you survive you get the key.You are just about to pull the trigger,and he says” wait a minute”.”Wear that ball and chain for another 12wks and I can almost guarentee that the gun won’t be loaded.
What do you do?I’d go for the extra 12 wks coward that I am,.but I’d really like to know the best way to do it,based on the best known evidence..I’ve just paid a vet $2400 to fix my cats broken leg.Friends think I am crazy,but my cat is my 2nd best friend,.sometimes even my 1st best friend.Whats an extra $2000 to save my life.If only I could be sure.But we have such a great opportunity with these generics at affordable prices,that others who are confronted with the full prices don’t have.