I have written a couple of times about the length of time for a Hepatitis C treatment, mostly about doing 12 weeks instead of 8 weeks when treating Genotype 1 with Harvoni, just to err on the side of caution.
However, whilst the length of treatment for for genotype 3 with Sofosbuvir + Daclatasvir should ideally be 24 weeks, many doctors still tell patients that they should only consider 12 weeks.
Because Hep C Genotype 3 represents more than 25% of all Hep C infections doubling the length of treatment time means a big extra expense for many people. As with genotype 1, insurance companies and government health services try to keep control of costs by recommending the shortest viable treatment time.
That is they choose the length of treatment time that will give the best results for the least money rather than the best results across the board.
Statistically if a person treats G3 for 12 weeks with Sof+ Dac then there is around an than 80% chance of getting a cure. If the treatment is for 24 weeks then the chance of a cure is better than 94%.
So this forces us into a situation where we must make a gambler's choice on our health. Do we save money with the shorter treatment and risk a relapse of spend the extra to increase the chance of clearing the HCV.
These questions can be demonstrated by a series of emails I have received from people over the last year. Obviously I can not put in all of the emails I have received but these I have included are very representative.
I received the email below yesterday from a person I had this conversation with about length of treatment for hep C genotype 3 around 9 months ago and it is the reason why I have visited this topic again.
I bought the medicine through you last year, I did a 12wk treatment for G3.
After the 12wk treatment period was up my virus load was 0, but I just find out that now (after 6months since my 'zero load' test) my virus load is back to where it was...
Any recommendations? I heard that there is a new medicine coming out by the end of the year that looks very promising for HepC G3. Do you know anything about it?
Looking forward to your reply,
And today I received 2 emails from 2 different people who had Hep C genotype 3.
Both also contacted me last year. One was from the Canada and one from the UK.
The guy from the UK was advised by his NHS doctor that 12 weeks treatment of Sof+ Dac would be enough to treat his G3.
The guy from the Canada decided to do 24 weeks.
One relapsed and one is cured... no prizes for guessing who.
Here are the emails:
Just wanted to let you know I am SVR24!!! and my liver stiffness has improved Fibroscan 14.6 before treatment to now being just 8.9. Another geno 3a that is cured using generic sof/dac 24wks. I read your diary all the time sorry to hear about the Serbia situation. Any help ever needed in Canada you can count on me.
.....I've been waiting for my 12 week after end of treatment tests to contact you.
I was already aware of the Hep symptoms returning, so unsurprised to find:
ALT 184, G3 viral load 11.5 million..
Back to the drawing board.
I know you recommended 6 months, not 3,.
The NHS consultant had said that with my liver having such a low scarring level I'd be fine with only 12 weeks of Sof+ Dac, basically told me not to do 24 weeks!
Any recommendations? I guess i could try again for 6 months, possibly adding Ribavarin to the mix.
Also there's a new combo out, Epclusa. Sof+ Velpatasvir... Any feedback for your end on that, especially after the failure of the Sof/dac.
I will give your suggestions more weight than the NHS this time round.
cheers Greg, Hope you're well, and so much thanks for your help and generosity
So in the case of a Genotype 3 relapse what are the options?
Well firstly the combination of Sofosbuvir + Velpatasvir ( Epclusa ) looks like it might be a little better for treating G3 than Sof + Dac. Generic Epclusa, named Sofosvel, is presently available from Beacon Industries in Bangladesh and costs US$900 for a 12 week treatment. Sofosvel is an unlicensed generic version of Epclusa.
A licensed version from India is available but only in Nepal as it has not been approved for sale in India. Because of this the price is quite high at around US$1,800. The other problem with this licensed generic Epclusa from Nepal is that I do not have reliable suppliers from there...
And there are a range of new drugs expected to be coming on the market soon that also hold promise for G3.
However what I come back to is that in the "here and now" if you are going to treat your Hep C G3 please do more than 12 weeks. At least 16 weeks and preferably 24 weeks.
One last thing to remember when treating any genotype of Hep C with Sofosbuvir and Daclatasvir. There is an enzyme in the body that breaks down Daclatasvir if you have high levels of this enzyme in your blood you will effectively under dose on Daclatavir.
There are two things that I know of which will cause high levels of this enzyme in your blood Taurine, a stimulant found in energy drinks such as Red Bull or V and also caffeine. So no energy drinks whilst doing Sof+ Dac and keep daily caffeine consumption low, a couple of cups of coffee or tea a day is fine.