The side effects of treatment with Sofosbuvir, Ledipasvir and Daclatasvir are typically mild and minor, however some patients taking these medications (from Gilead, BMS, etc) have suffered significant side effects or died.

The typical issues reported are:

  • fatigue
  • headache
  • nausea
  • insomnia

If ribavirin is used we can add in:

  • anaemia (low red cells in blood)
  • neutropenia (low white cells in blood)
  • thrombocytopenia (low platelets in the blood)
  • photosensitivity (easy burning in the sun)
  • myalgia/arthralgia (aching joints and muscles)
  • tiredness
  • riba rage (mental changes)

Having Hepatitis C is not safe. The risk of a severe adverse effect occurring while taking treatment is far less, but it is real. These medications are safe, but they are not 100% safe.

These lists are not exhaustive, but to put things in perspective one patient noted that "compared to interferon this is a walk in the park"

Starting Treatment

Most patients experience a mild flu like illness on starting treatment.

Within a week this is usually replaced by feeling "better than I've felt in years".

Before starting any treatment please refer to the relevant consumer medication information and prescriber medication information paying particular attention to drug interactions.

Hepatitis B Reactivation

A small number of patients with chronic Hepatitis B - that is a negative HBV surface Antibody (demonstrating lack of immunity) and a positive HBV core Antibody (demonstrating prior exposure) - have been observed to reactivate their Hepatitis B as demonstrated by rising levels of HBV surface Antigen and HBV PCR DNA. It seems sensible to place such patients on prophylactic Entecavir or Tenofovir for at least 6 months after SVR12. Both Entecavir and Tenofovir can be sourced as generics for patients that require them.

Liver Cancer Risks

There has been quite a lot written about the risk of developing liver cancer post treatment. The most up to date summary on this was provided at the EASL ILC 2017 in Amsterdam. Here is the press release on it:

ILC 2017: Is direct-acting antiviral therapy for Hepatitis C associated with an increased risk of liver cancer? The debate continues

The executive summary is that patients without cirrhosis have no significant risk and patients with cirrhosis probably have no more and no less than their existing risk. Cirrhotic patients require close monitoring for HCC in any event, and patients who have already had an HCC require diligent monitoring during, and immediately after DAA treatment.

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