Hi Serg,
24 weeks Sof/Led or Sof/Dac alone should give you a 99% SVR probability.
- F4 is a weak negative predictor.
- High viral load (assuming you are > 6 million) says definitely do 12 not 8
- Past failure is your major issue as it drops the 97% SVR to 94% @12 weeks but this pulls up to 99% @ 24 weeks.
As you note there is a slightly different resistance profile for Led and Dac. You already have all your RAVs even if we can’t measure them. These drugs are not mutagenic, they simple expose RAVs by selection.
Please note that the following advice has relatively little proven scientific basis (in trials data) but if you’re going to do 24 weeks – and that is the right choice – then 12 weeks Sof+Dac and 12 weeks Sof+Led gives you 24 weeks Sof + exposure to 2 different NS5As, so if you have a few mutants left at the end of the first 12 weeks, the second 12 weeks should do the job on these stragglers.
1b is the easiest to clear, so you are looking at great odds without Asunaprevir.
Asunaprevir, like all NS3/4 agents, is a bit toxic. I would suggest keeping it up your sleeve as the Plan B if the 99% odds of 24 weeks of 2 DAAs don’t work for you.
I would not bother with the Ribavirin. It will add little or nothing to your SVR probability on a 24 week treatment course, but it will make you suffer during treatment.
If you go here: http://fixhepc.com/hcv you will find a tool that contains the EASL and AASLD guidelines, but more importantly if you put in your numbers and then use the “Show Trials” button at the end of the results it will show you pretty much everything that is known in terms of hard data.
.
