Hello Protagor,

Genotype 1 is easier to cure than Genotype 3.

Cirrhosis makes patients harder to cure and both patients have cirrhosis.

Women are (slightly) easier to cure than men

While it is entirely possible both patients will be cured with 12 weeks Sof+Dac+Riba

1) The response of the man with GT1 is slow – a viral load of 148 @ 4 weeks is unusually high. I would estimate his current chances of cure at 85-90% rather than the ~95% we expect

2) The response of the woman with GT3 is much better (at 4 weeks test) but expected cure rate for GT3 with cirrhosis is 90% with 12 weeks treatment.

The effect of extra treatment is small. In rough terms adding 4 weeks (so 16 weeks total) might add 4% to cure rate, adding another 4 weeks (so 20 weeks total) might add an extra 2% and adding another 4 weeks (so 24 weeks total) might add 1%

What you should see is that going from 12 weeks to 16 does add quite a bit to cure rate, but each extra lot of treatment adds less benefit.

For both patients I would suggest going out to 16 weeks total or longer if this can be afforded. For GT3 patient I would like more than 16 weeks if this is possible.

Daclatasvir does have some drug and food interactions that can either raise or lower the levels in the blood. Are any other medications being taken? What does diet of both people look like – is it the same food every day or is there good variety? (if good day to day variety any problem food does not tend to appear for many days in a row).

Hi Sven,

Ah the 70’s – you’d never get away with an 8 minute song these days, not even > 4 minutes – unless of course it was:

https://www.youtube.com/watch?v=fJ9rUzIMcZQ

Hi KarenB,

The waiting for the results can be hard. Trust the statistics – the odds are very much in your favour.

Best wishes

Hello KarenB,

Your enzymes look great. You can have a sneak peek at them before SVR12 if you are worrying. If they stay down you are good.

Hello beahaven – from your F0-F1 starting point your HCC risk is pretty much the same as the general population (ie very small).

Normal, F0 and F1 are all close together. F3 and F4 are close together. F2 is a middle ground. You are at the lowest possible end for fibrosis and the lowest possible risk for HCC. While there is a push to extend surveillance to F3 patients there is not a push to extend it to F2 or F1 or F0.

Your doctor would seem to be being over cautious. Monitoring your AFP is almost certainly sufficient (if you are of a paranoid disposition), particularly if funds are tight.

If you were my patient I would not be monitoring you for HCC (with either AFP or U/S) and would have declared you cured.

The occasional patient with F0, F1 and F2 will get an HCC. So to will the occasional patient who does not have Hep C (or Hep or any other liver issue.

Hi G,

Drop me a line by email and we’ll get going.

Best Regards

James

Hi barry666,

I’m pretty sure I copied you into an email to Prof Gane so you have my email address.

If you can get your specialist or GP to a) Prescribe you 16 weeks Maviret and b) Fill in a Medsafe form for 16 weeks Sofosbuvir we can (potentially) get just cracking now for you.