Thanks for posting this. Have been reading most all the material available online regarding HCV retreatment. The collection of work presented here by David Wyles MD at UCSD is interesting to be sure.

From the perspective of a patient seeking retreatment – I view information such as this as very encouraging – though academic.

Using the existing AASLD guidelines for initial therapy – medical coverage here in the States for approved HCV DAA medicines is often denied to patients without significant fibrosis scores.

Following the new and current AASLD guidelines for retreatment – “deferral of treatment” is recommended for patients who do not have cirrhosis and do not have reasons for urgent retreatment.

http://www.hcvguidelines.org/full-report/retreatment-persons-whom-prior-therapy-has-failed

Most any retreatment plan using approved HCV medicines here will be unavailable through medical insurance with the existing guidelines and drug costs – emphasis on the latter.

Using the flow chart shown above from Wyles’ presentation – the most basic retreatment option (no NS5A RAVs) calls for 24 weeks of Harvoni – current retail price here is just over $183,000 USD. The base retreatment option when some known NS5A RAVs are present calls for 24 weeks of Sovaldi and Olysio with ribavirin – current retail price here is over $305,000 USD.

While government agencies and insurers have negotiated significant price discounts from the drug manufacturers – these reduced prices are not available to individual patients seeking treatment.

Any realistic retreatment regiment is thereby limited to available generic medicines. This means that new drug studies – however promising – will only produce practical results sometime in the future when and if such medicines are manufactured as generics. Note that Olysio (simeprevir) – currently recommended for retreatment – has yet to become readily available as a generic.

Crossing the first hurdle for treatment has only just recently become a reality for many with the availability of generics. The second hurdle for retreatment is somewhat higher making resources such as FixHepC and access to affordable generic medicines even more important.

J