Welcome AK123,

These new DAA treatments don’t require the same levels of monitoring as peg/riba did (and are much less debilitating) but there appears to be a fair bit of variability in what is seen as the optimum level by various clinics/doctors. If you click on this link https://fixhepc.com and scroll down to the section titled “Important information for Australian Hep C sufferers” you will find a couple of videos covering what would make me as a patient comfortable during treatment, along with other information that may be useful to you. It’s difficult for me to comment on length of treatment as that needs to be assessed by a doctor based on a number of factors including your fibrosis level which you haven’t noted.

Also, assuming ribavirin isn’t part of your current treatment then your response to the Sof/Dac seems atypical or at least stronger than what most people report although there can be a bit of an up and down effect for some of us during treatment. Daklinza in particular can react with some drugs and foods which can increase side effects, below are a couple of links explaining some of those which may help if you are taking/eating something listed.

https://fixhepc.com/forum/drug-interactions/108-daclatasvir-warning-interactions-cyp3a4.html

https://fixhepc.com/forum/drug-interactions/611-cyp3a4-inhibitors-and-daclatasvir-fruits.html

Coffee is a weak ‘inhibitor’ so unless you are drinking large quantities (or are very light weight) it probably won’t have much effect though would be easy to reduce for a couple of days to see what difference it makes.

Something else I should have mentioned is that most of us find that being well hydrated helps reduce any sides so drink plenty of water through the day but if these problems continue to worry you should discuss them with either your clinic or a doctor with experience with HCV.

For GT3 there is some evidence that 16 weeks may be better than 12 for patients with low fibrosis. Velpatasvir is more potent than Daclatasvir so may get better results with 12 weeks. On the data it looks quite similar.

Retreatment of GT3 is harder. Sofosbuvir+Zepatier is certainly an option. Using Sofosbuvir+Daclatasvir+Interferon+Riba is another. There are some more experimental options like V-pak+Sofosbuvir being trialled. The key approach is more than 2 drug therapy with NS3/4 + NS5A + NS5B + Non DAA (ie Riba and or Interferon). The basis or retreatment logic is not to repeat the same thing and use stronger, longer and/or Ribavirin – pick 2 or more.

Most people won’t have to contemplate it. Costs are typically 3-4x the cost of initial treatment using a mix of generics and originator medication sourced from places where it’s cheaper like Eqypt or Russia.

I’m not an expert but as your nurse says, there isn’t a huge amount of data on extending GT3 treatment naive with F0/1. I suspect 16 weeks gives you a really good chance of beating this virus and that extending further would be really getting into the area of diminishing returns though it may possibly give you a percent or two if you haven’t already cleared.

Your liver ‘twinges’ are something that have been commented on by others including myself. They seem to occur both during and post treatment and as far as I have seen don’t seem to correlate with whether people reach SVR or not. I still experience them sometimes but my specialist can find no reason for them despite lots of checks including various scans, etc. Having said that, do discuss them with your clinic.

Weight? Sigh, I put on 6kg on treatment myself despite significantly increasing my exercise and fitness. I’m not sure whether it was because I had a better appetite or because I was metabolising my food better but it has taken six months to finally get rid of them which I understand is beneficial for anyone with liver complications. (Edit: I do find I can tolerate fats much better these days so don’t specifically avoid them as much and that may be something to consider)

I plan to reassess my treatment duration pending the outcome of the (much awaited) first results.

If I was you I would not be doing that.

While undetected at 4 weeks is a good sign, undetected at 12 weeks is essentially meaningless. Everyone is undetected by this stage. In other words this result informs nothing. Yes, nice to see, but useful or informing treatment duration – no.