Thanks for posting this. Have been reading most all the material available online regarding HCV retreatment. The collection of work presented here by David Wyles MD at UCSD is interesting to be sure.

From the perspective of a patient seeking retreatment – I view information such as this as very encouraging – though academic.

Using the existing AASLD guidelines for initial therapy – medical coverage here in the States for approved HCV DAA medicines is often denied to patients without significant fibrosis scores.

Following the new and current AASLD guidelines for retreatment – “deferral of treatment” is recommended for patients who do not have cirrhosis and do not have reasons for urgent retreatment.

http://www.hcvguidelines.org/full-report/retreatment-persons-whom-prior-therapy-has-failed

Most any retreatment plan using approved HCV medicines here will be unavailable through medical insurance with the existing guidelines and drug costs – emphasis on the latter.

Using the flow chart shown above from Wyles’ presentation – the most basic retreatment option (no NS5A RAVs) calls for 24 weeks of Harvoni – current retail price here is just over $183,000 USD. The base retreatment option when some known NS5A RAVs are present calls for 24 weeks of Sovaldi and Olysio with ribavirin – current retail price here is over $305,000 USD.

While government agencies and insurers have negotiated significant price discounts from the drug manufacturers – these reduced prices are not available to individual patients seeking treatment.

Any realistic retreatment regiment is thereby limited to available generic medicines. This means that new drug studies – however promising – will only produce practical results sometime in the future when and if such medicines are manufactured as generics. Note that Olysio (simeprevir) – currently recommended for retreatment – has yet to become readily available as a generic.

Crossing the first hurdle for treatment has only just recently become a reality for many with the availability of generics. The second hurdle for retreatment is somewhat higher making resources such as FixHepC and access to affordable generic medicines even more important.

J

Yes TM ….

The SVR numbers for GT1a patients treated with Vieira Pak + RBV are reportedly very good – certainly on par with Harvoni from my understanding. Unfortunately – I fell into that few percent of patients that couldn’t get it right the first time.

Had HCV drug resistance testing performed after treatment by both Monogram Biosciences (LabCorp) and Quest Diagnostics (just NS5a for the latter).

Results showed the presence of NS5a drug resistant Q30R – tested resistant/probable against all available DAA’s with the exception of velpatasvir (test was unavailable at the time). From my reading – it appears that Q30R is likely resistant to velpatasvir as well.

How each of these NS5a inhibitors perform against Q30R in practice – and when combined with other DAAs – is the subject of trials.

Very fortunately – my tests showed no NS3/4a or NS5b RAVs – most importantly no NS3 Q80K that may have precluded retreatment with simeprevir. From my reading – prevalence or the Q80K RAV varies widely by geography with North America ranking at or near the top. Over one-third of GT1a patients here reportedly test positive for Q80K. Dr. Freeman has a post on the forum that discusses this:

http://fixhepc.com/forum/experts-corner/1077-geographic-differences-between-gt-1a.html#17705

My apologies for the late response to your earlier post.

J

You need to talk with Dr. Freeman, http://www.gp2u.com. He is the expert here. He will cure you.

Thanks GF …. I took your advice ….

J

Congratulations on SVR12!

Hi J,

I can see by your profile what you went through to beat this virus. I’m so so happy that your story has had a happy ending.

The cost of treatment that you relay is obscene and prohibitive to so many.

Coral