Something happened in the middle of the week 5. It first started with blurred vision and some general weakness. I had to go home from work because I could not see much in the computer screen. That blurred vision and weakness soon passed, but ever since that day I am having liver pain – sometimes sharp, sometimes dull pain in my liver region. I have had similar pain before, but never so intense. It is quite unpleasant, present for the most time of the day. I had F2 level fibrosis in biopsy 10 years ago, but liver density measurement showed F1 last year, so I am not exactly sure how damaged my liver is.

What people forget is that just because you have Hep C and just because you are taking treatment…. all the other medical events that happen to people in their 40s, 50s and 60s still happen at the usual rates.

This event sounds like a Transient Ischamic Attack (TIA) otherwise known as a mini stroke. You need Blood Pressure, Cholesterol, Doppler U/S of carotid arteries. 1/2 an ordinary aspirin a day (150 mg) is probably a good idea. Fixing Blood Pressure, and treatment with a Statin (almost regardless of Cholesterol level) decrease the chances of recurrence. Please talk to your doctor about it and get those tests done.

Hello Spook,

Sorry to hear that. The basic guidelines for retreatment are longer, stronger, add ribavirin – pick at least 2.

There is more on this here: http://fixhepc.com/forum/retreatment-corner.html

Although prices have fallen over the last year the longer/stronger bit means it will probably cost more for retreatment. You would be wise to wait about 6 months to get access to Sofosbuvir + Velpatasvir + Voxilaprevir which will be available this year (when the Vox arrives) and cheaper than anything of similar “kick ass” potency available now.

The current system is 90% broken. Or maybe it’s 50% broken, but regardless of what number you want to put on it the reality is that Big Pharma is failing to adequately look after the citizen payers that fund it.

It’s worth reading my article from Liver International for an overview http://onlinelibrary.wiley.com/doi/10.1111/liv.13157/full which covers off on a lot of the arguments. Like the 19 x disparity between spending on marketing (25% of gross revenues) and R&D (1.3% of gross revenues)

Profit is a great motivator but as things stand we have a massive lack of innovation because there is more profit to be made at lower risk by minimal modification “me to” drugs and simply ever-greening existing technology through trivial chemical modification. TDF and TAF for HIV are a perfect example of “non innovation” being granted a new patent. The fact that Gilead has pushed the more poisonous TDF onto patients despite developing the lest toxic TAF form of Tenofovir at the same time should be cause for global outrage. It isn’t, but it should be.

For those that don’t know Tenofovir is an HIV/Hep B treatment. The active bit is Tenofovir. The salt bit is either disoproxil fumarate (TDF) or alafenamide (TAF). TDF causes long term side effects. TAF can be taken at a lower dose and causes less. Both were invented at the same time (no doubt along with many other salts of Tenofovir) but TAF was shelved so it could be rolled out as “New improved Tenofovir” but more importantly with a “new patent”. This is bullshit, scamming and ripping off the insurers and taxpayers. It’s better than “New Coke” but at least they did not get to patent that. Pushing forward something more toxic (when you have something less toxic) should be a “Do not pass go, go directly to jail” offence. If not that a “Please explain” congressional hearing. And failing that a “Go and stand in the naughty corner”.

It took a long time for things to get this broken, and it will take a long time to modify things to favour new innovation, however it is something that has to happen.

The simplest way for “fix” drug pricing is to apply market forces.

Parallel imports from allied markets ie From Canada -> USA would halve US drug prices more or less overnight. I expect this is what will transpire as it is the path of least resistance.

Hello Jorge,

Your skin is mostly dead layers peeling off, so even if we could just wave a magic wand and cure the cause your skin would not magically change at that moment.

I presume things are cyclical with better and worse bits. In the event treatment helps it would still take as long as it usually does to settle down, more or less.

I plan to reassess my treatment duration pending the outcome of the (much awaited) first results.

If I was you I would not be doing that.

While undetected at 4 weeks is a good sign, undetected at 12 weeks is essentially meaningless. Everyone is undetected by this stage. In other words this result informs nothing. Yes, nice to see, but useful or informing treatment duration – no.

MELD is short for “Model of End stage Liver Disease”

It’s utility is for sick people.

In interpreting the MELD Score in hospitalized patients, the 3 month mortality is:

40 or more — 71.3% mortality
30–39 — 52.6% mortality
20–29 — 19.6% mortality
10–19 — 6.0% mortality
<9 — 1.9% mortality

So at MELD <9 that 1.9% mortality represents about what you'd expect when you consider that's about the average annual death rate for adults ie these patients are dying of other things at expected rates, rather than liver disease.

Although it can be a bit of a crap shoot, if there is a UK script my undesrtanding is that VAT can be avoided. If there is not a UK script it can’t (unless they forget about it which does happen).

Anyone travelling to Bangladesh may find either of the following contacts useful

Beacon: masfik@beaconpharma.com.bd

Incepta: alimul@inceptapharma.com

Pharma companies are not retail Pharma-cies so arrangements are best made in advance.

It’s not a big drama but don’t just arrive and expect the world to be Western. It isn’t.

Make contact in advance. Outline your requirements and everything will happen.