You may like to try reducing the dose of Daclatasvir to 30 mg for 1-2 days. If you find your side effects seem to moderate that would suggest that for your small size the 60 mg dose is just a bit too big. Increase it back to 60 daily and if the side effects come back you could call that a smoking gun.

You are, by weight, getting twice the mg/kg dose somebody of 100 kg gets, so such an experiment is unlikely to cause any harm.

Sadly most of the free programs are marketing, and much less actually treating.

Hi Em So glad to hear you are well. Enjoy your trip up North (I hate heat and humidity so tend to go to cooler places when I do a trip). All good here in Bendigo (albeit bloody cold!!!) I am keeping well and of course am ever grateful to James and his team. I don’t post often but do visit the Forum regularly.

Cheers Lynne

Hello 2bornot2b,

26 is ok. About 22% of people return a reading greater than undetected at the 4 week mark. It’s nothing to panic about but does require consideration.

In the original trials <25 was the standard (that was the best we had). We now have better tests that go down to <15, <12 and even <10. I still get some <30 results.

The significance for you is that of patients that fail to SVR 44% will still be detected at this point (like you) against 22% in the group that do SVR.

This produces an Odds Ratio (OR) of around 2. Without boring you with the maths too much the chances of success with GT2 are very high - probably genuinely around 97% so there is a 3% failure rate

For you, being still detected that 3% and OR of 2 looks like a 6% failure rate. Still good odds at about 94% but slightly lower than a patient who is undetected at 4 weeks.

In our data we have saw 32/448 patients still detected at end of treatment. Even then 75% (24/32) still went on to SVR. Your result is much better than theirs.

So what we have seen is a slightly less speedy response from you. It is still a very good response, just a little slower. What it means is that there is going to be less over-treatment buffer in the last 4 weeks or so than there is for someone who has fallen faster. You can probably imagine a faster response gets to absolute zero faster, and that's when we win.

One option to consider would be to add in 4 weeks of extra treatment. You should not need more than that.

What you don't mention is whether you are you on Sofosbuvir+Velpatasvir or Sofosbuvir+Daclatasvir?

We have 38/38 SVR12 with Sof+Dac but the results for Vel are still waiting for enough time to have passed.

Hi Emilio,

Great to see you passing through!

As I recall you were the first patient here to breach anonymity and actually show your face.

It seems a bit more normal now, but at the time, I went here’s a bloke with cojones.

Thanks for all the assistance you provided back in the early days when we were all making it up as we went along.

It’s come a fair way since then, and a couple of weeks ago we presented to EASL again – after Merck and before Gilead with their new 6-12 yo study. It turned out pretty good in the end.

http://fixhepc.com/blog/item/79-easl-2017-generics-results.html

It’s great that you’re cured!

Simeprevir is now increasingly hard to find, but on the good news front there are other options and good 3 drug treatment can be done for about $2000/12 weeks with good options – depending on genotype. So in ballpark terms it now cost 1/2 what it did 12 months ago.

Prices should continue to fall but 3 drugs, and longer durations do mean it will never be quite as cheap as the first go with a good 2 drug combo. Most people go well on the 2DT which is nice, but it’s good to know there are stronger things available for the small % that don’t get it done first time round.

The notion is that 12 weeks should be sufficient but I can understand people wanting to overtreat a bit.

3DT – 3 Drug Therapy is the standard of care for another unstable RNA virus, namely HIV

Targeting all of NS3/4A, NS5A and NS5B puts the laws of probability on your side.

If the chances of getting a mutation are 1:1000 (it’s more like 1:10,000) but go with me.

Then the chances of getting another on the same strand of RNA are 1:1,000,000 (1000*1000)

And the chances of getting a third are 1:1,000,000,000

Those odds look pretty dang good.

For retreatment if you can get 3 pretty good agents that target our 3 targets, your chances are really good of getting SVR.

Don’t stop

What Mnem said….