You need stomach acidity to help Ledipasvir absorbtion.

I recommend Daclatasvir for anyone on a PPI who can not stop it because of this issue. Some people exercise their free will and subscribe to the Harvoni is better marketing.

• If your heartburn is worse at night, put some bricks under the head of your bed to allow gravity to help keep the acid in your stomach.
• If your heartburn is made worse by certain foods don’t eat them, take less PPI during treatment.
• If you must take a PPI take the smallest dose possible.
• If you must take a PPI take it 2 hours after the Ledipasvir so you are loading the Led during the most acidic time and there is time for it to be absorbed.
• If you are small in bodyweight you are getting more of a dose in mg/kg terms than if you are large where a small reduction may be significant.

I do know of some doctors giving Sof+Led+Dac. It is experimental although the results of a 50 patient series I have seen are very impressive. It is not recommended in any guidelines but might be an idea to add Daclatasvir if you were say largish and could not stop the PPI.

Yes, you could make a good case for just take a course of Nexium HP7 while waiting for meds to arrive. 7 days of Nexium + Antibiotics.

I think the best thing to do is follow the guidelines and either do Sof+Led or Sof+Dac.

The theoretical problem with Sof+Led+Dac is this:

Have you ever tried to walk through a door at the same time as another person – neither of you fit but alone you do.

Drugs work like a key in a lock so it’s entirely possible that 2 drugs can “fight each other” and make the combination WORSE than either drug alone.

If you must take a PPI and have Dac then do Sof+Dac.

Mike,
A significant cause of tx failure with Harvoni is the presence of baseline NS5A RAVs. The only way to tell if you have them is to test for them before tx. This is being talked about but it is not yet being done. For example, if you knew you had these RAVs you might want to think about extending tx.

Here is a link to a discussion about this.
http://www.clinicaloptions.com/Hepatitis/Conference%20Coverage/Vienna%202015/Clinical%20Thoughts/CT1.aspx

dt

The test is not really available yet so I’m afraid it is really pot luck. No other way to estimate the probability that you will be in the 95% who achieve SVR with 12 weeks or the 5% who don’t. Current data says that the 4-week test is not a predictor of success. So you pays your money and you takes your choice. I hate it but that’s how it is.
Good luck,
dt

Well, it sounds like longer is better to a certain point. If the svr rate is 95% for 12 weeks and 100% for 24, then its looks like you get about a 1.3% increase in your chances of achieving svr for each 4 week extension of treatment up to 24 weeks.
Does that sound right to you or am I missing something here?
Thanks
Mike

Mike,

Only 12 weeks and 24 weeks have been tested so we are into the realms of speculation here.
If the chances are linear with time then your conclusion would be correct, but is that so? I don’t know. How long past 12 weeks does it take to eliminate the last group of resistant mutations capable of rebounding back into full HCV infection, if they are indeed still present at 12 weeks? There are different kinds of variants with different fitness levels, so which kind are still present and needing to be knocked off? Some kinds might go in another 4 weeks, some kinds might take longer. How long is a piece of string? In the 24 week tests we don’t know if the last virions standing were still standing right up until the day before the 24 weeks were up, we just know that they were no longer infectious after week 24.

Wish I could give you more of the certainty you are looking for but I can only add that this virus is a tricky m.fucker and the one thing there’s not a lot of in its treatment is certainty. Not yet anyway. For this reason I am doing 24 weeks rather than the 12 recommended for my circumstances. Even then, I won’t be sure until I get my SVR24, so you are talking to the completely wrong person for an assurance that less than 24 should be fine. That’s a roll of the dice I’m afraid.

So you can do the 12 weeks and take the 95% and see what happens, then retreat if you are unlucky. That is a valid option. Depends on how that fits into your life. For me I’m 65 with 2 failed treatments behind me. I really need to finish it this time, whatever it takes.

My very best
dt