LG,

Well, it’s up to you, but if it were me I’d err on the side of caution and go with Dr F’s assessment until proven otherwise. As you have decided to do 24 weeks anyway, determining cirrhosis or not doesn’t matter now in terms of making that decision. I understand that the sudden news of possible cirrhosis would be a big shock. My recipe is that now you have made the big decision to go 24 weeks, just take the next days one at a time. The main thing is to maintain an optimistic view based on the realistic chances that your tx will be successful. Again, go over the Gilead trial results. Even cirrhoics on 24 weeks had high odds of success.

I also switched from led to dac at 12 weeks. I put a lot of study time into the led & dac Ravs question. My conclusion is that if you fail tx and you are left with NS5A RAVs then you are. Whether it’s both kinds or just one kind isn’t going to matter a lot. The choice is to use up your biggest guns first time around or keep something in reserve for another round. You have to balance that by considering that your chances of success on the first round are better than on subsequent rounds with the current DAAs. My choice has been to use the big guns up front. If it does not work then I’ll wait for velpatasvir which is rumoured to plough through all RAVs, no matter what kind. But we’ll have to wait and see about that. Anyway, there will be something coming that will be strong enough to do that – hopefully.

I still think the gene test will be superfluous. Some RAVs are sensitive to led, some RAVs are sensitive to dac, some RAVs are difficult to clear for both drugs and just need to be battered for a long time. Remember that it is Sof that does most of the battering, not the led or dac. But I’m not a doctor. If doc Freeman thinks it’s worth while then it is. If you do go ahead with the testing then yes, you can test for NS3 resistance (simeprevir) as well. There’s info on this post from somebody who got the testing done:
http://fixhepc.com/forum/patient-stories/744-viekira-rbv-failure-retreatment.html?limitstart=0

dt

Hi LG

I am not surprised that you feel your brains are a bit scrambled right now. In your position who wouldn’t. I am also aware that there is a time pressure on you to obtain your next 12 weeks of meds before you run out. So here’s what I think is important for you to focus on right now:

a) the malabsorption issue, if there is one, needs attending to. Ovbiously, you need to be absorbing the meds properly for them to work.

b) the choice of which drug(s) you are going to order, and get the order in.

———————————————————————————————————————

Here’s a few factors which are relevant to b):
–
Simeprevir seems to be difficult and expensive to obtain. Can you get simeprevir in the time frame? If not, forget about that option.
–
Here’s my take on Resistance Testing for RAVs.
The subject of resistance is huge. I’m not sure that you can get the testing done in the timeframe that you have, but I don’t know for sure.
The purpose of resistance testing is to more effectively target the RAVs that are found. This is a good principle and would also be a good practice if we had a whole array of DAAs in our arsenal to target with, but we don’t. Therefore at the current time the choices are to go with what we’ve got and hope for the best, or wait for something better. Now for people who are trying to decide on their next tx the testing is useful because it gives them a better chance of predicting their chances of success based on their particular crop of RAVs and the capabilities of the drugs that they can get. If it doesn’t look hopeful then they can wait. But for people like you who have already started tx you don’t have the choice to wait. You’ve started and while there is hope (and there’s plenty) you need to keep on going. So no matter what the testing finds – led RAVs, dac RAVs, NS3 RAVs, RAVs with cross resistance, what are you going to do? Quit because you have all these RAVs? No, you are going to keep on going and hammer the hell out of them and take your chances. Your first time round is your best chance.

Best wishes,
dt

how do I go about absorbing them better? Diet? With food?

You are right LG. This is a whole big area that I know little about except the common knowledge you’ve already come across here.
ie.
LED has absorption issues if there’s not enough stomach acid present.
DAC has absorption issues with interference with CYP3A4 pathways.

Re ravs, I guess I’m worried about lessening my options for the future now

I think it is fine to stick to LED for the 24 weeks if you would feel happier with that. All the Gilead studies apply to 24 weeks of LED so that is the tested way to go. Switching from LED to DAC has not been tested at all, so in that sense it is more risky. I would never advise on going one way or the other, I just made the decision for myself. I can’t tell you that it’s worked but so far so good. Bloods good and UND.

dt

I think this scan nxt weekend would help me decide, if there is cirrhosis or not, hopefully I will find out

I can understand that this question must be giving you a lot of anxiety and you want an answer on it.
What I’m not sure about is how that answer will help you decide on anything? As far as I’m aware, the only decision that is relevant to cirrhosis is whether to treat for 12 or 24 weeks. As I understand it, 24 weeks is already decided upon.

If you are just needing a milestone in the future as a way of delaying your decision while you gather your wits about you and consult with your doctors then that is very reasonable. Otherwise, with time not on your side, I’m not sure what factors to the decision making process that you hope to gain based on the results of your upcoming scan.

dt

I am looking at your stats, I can see you’re like me a late respond-er if memory serves me correct your
Fiber score was F2 7.4 now its being suggested you’re a F4 17/20, you’re also a G1 which responds well
too this treatment.

I know,fiber scans can be off I have never heard of it being off too that degree,I think you said James
thinks you’re a F4 is is possible he is saying you’re Acting like a F4, by this he means you’re reacting like someone
cirrhotic slow to respond they are two different things. He said same too me it all worked out my end.

Sure, you’re Viral load is going down albeit slower then others, if you recall my own Viral load tests at
at week 6 was 17 higher then you it was still detected then week 10 its Undetected you still have six weeks
plus to get undetected.

I think this needs some very careful evaluating I don’t think you’re F4 we all have some scarring on our livers
its not something I’ve ever worried about.