Interesting. What are the white lines all about?

If you’re otherwise well I would not worry about it and just keep an eye on things. If it gets worse…..

Rashes and stomach upset are the two commonest drug reactions

With DAA treatment we try to stop as soon as possible to get an acceptable cure rate.

HCV replicons take about 6 weeks to decay so it’s entirely possible the detection relates to a “less than critical mass” residual bit of RNA.

6 patients 6-61 days past EOT is not enough – either volume of patients, and time from EOT to draw any conclusions.

Being a pragmatist what we want is cessation of disease progression and symptoms. The evidence to date suggests we do get that, however it’s been known since 2004 that you can still find traces of HCV at SVR. That’s the reason it gets called SVR rather than cure,

http://www.ncbi.nlm.nih.gov/pubmed/15140984

For practical purposes SVR is cure – at least for Interferon because we have long term follow up showing SVR is durable and the virus does not come back.

http://www.sciencedirect.com/science/article/pii/S1413867010700702
http://www.medscape.com/viewarticle/782532

They say (who are they anyway) that GT3 is the wolf in sheeps clothing. Nothing much for years, then bam – up goes the fibrosis.

This is a relationship to age with the wheels tending to fall off after 60, but the youngest cirrhotic I’ve met was 28 – he had HCV/HBV coinfection and has sadly passed away having achieved SVR too late.

At the time I had a classical guitar so just had to learn the riff from this:

https://www.youtube.com/watch?v=ZD7bnaZWOao

Hi James,

Don’t sweat it too much. I do suggest setting an alarm but you blood levels do this when you take once a day medications:

So you can see they go up and down every day, and increase fast to start with and then slow.

The high point is called the peak and the low point the trough. If you are late with a dose all that happens is that the trough level falls a bit more. Provided that the trough is still above the MIC (Minimum Inhibitory Concentration) then the virus gets no opportunity to capitalise. The standard dose gives you plenty of wiggle room on the MIC and the only circumstance it might matter even a little bit is a long delay in the context of some pretty nasty RAVs.

So, do take it as close to the same time each day as you can, but don’t panic if you’re a bit late, or even if you miss a day (most people do this).

I had one patient – GT2 to be fair so easy to cure – who took his meds for 4 weeks, forgot them for a 2 week holiday, took them for another 4 weeks and then just left the rest in the bottle. Lucky bastard still got SVR12 which seems totally unrighteous, but there you go.

Many years ago my brother told me:

“In the race between the greater good and self interest, back self interest every time”

It took me a good 20 years to understand……

Sadly doctors are not immune to this.

At the moment I feel like the little boy saying the king – aka Big Pharma – has no clothes.

It’s only a matter of time before others see, but it is remarkably lonely.