TOPIC: Expert Professor by email - September 13th

A few comments on the website and related generic initiative:

1. The website is really well set-up, with very accessible information.
2. The advice re prolongation of treatment based on HCV viral load monitoring is incorrect. There is no relationship between on-treatment monitoring and treatment outcome (assuming high level adherence, as in clinical trials). In fact, many patients in clinical trials have had "detectable" HCV RNA at end-of-treatment and still achieve sustained viral clearance. There is clearly no relationship between week 4 (or other timepoints) and sustained viral clearance, so extending treatment duration (as we did with interferon-based treatment) does not make sense in the interferon-free era, including in the case described below.
3. HCV RNA monitoring is probably only useful for adherence monitoring (or purity monitoring in case of generics). So, would still advise a week 4 HCV viral load, based on adherence/purity monitoring.
4. Treatment duration may need to be longer (24 weeks), based on pre-treatment factors (e.g. SOF/LDV or SOF/DCV for GT1 cirrhosis treatment experienced; SOF/DCV for GT3 cirrhosis treatment naive and experienced).
5. It is very important that the only patients that use SOF/ribavirin 12 weeks are those with GT2 (and possibly GT4 for 24 weeks). It is a sub-optimal regimen for GT1 and GT3.
6. The field is moving so quickly at present that there is a real need to keep updating. The AASLD/IDSA guidelines are probably the most frequently updated, and should soon have guidance on SOF/DCV. EASL guidelines are good for SOF/DCV.

I do understand patients desperation

* Comment - the site content has been corrected in line with point 2

Hi Prof

Wow point 2 is something that I'm still attempting to process. Having treated about 7 years ago with the older chemicals this is a concept I struggle to comprehend. 'Some being detectable at the end of treatment but go on to svr'. Obviously this research has been developed from the more recent DAA research, can you point us in the direction of this data? Em

Dr Freeman

Point 2 has been a question in my mind for some time. I am glad to get a definitive answer on it, thanks. As you say, things are moving very fast in the hepc world. I seem to find out new info daily, and lately from this website which is turning out to be a very valuable source.

dt

I have it on good authority:

The information on end of treatment "detectable" HCV RNA and SVR was contained in presentations at EASL Conference in April, so not yet fully published.