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The New Hep C treatment
Jan 4, 2014

Dear Dr. Taylor

First, thank you for the time you give on this site. It is very helpful.

I was diagnosed with Hep C (genotype 1A) way back in 1994. I have been unsuccessfully treated three previous times, the last in 2003. Although I treatments had an overall positive outcome, I was never clear of the virus. Further after the last treatment I became totally interferon intolerant.

I became co-infected with HIV in 2005 (and have been undetectable since 2006 and have T-cells and other reading in the range of a normal uninfected person.) For my HIV I am on regimen Truvada (once daily) and Insentress (twice daily). Just last month it was determine that I am at Stage 3 (out of 4) regarding liver cirrhosis.

I started 2 days ago a 12 week combined treatment of Simeprevir + sofosbuvir + ribovirin. My question is that nowhere in my reading of the new treatment do I see anyone recommending the combination I am taking. The first two combined yes but not with a third drug. Your thoughts please as to whether it seeming a correct and effective choice to prescribe.

Many thanks, Steven

Response from Dr. Taylor

WOW Steven it is incredible that your doctor was able to get you this combination! Simeprevir and sofosbuvir were both just recently approved by the FDA in the U.S. They were both approved for use WITH interferon for genotype 1 hepatitis C infection, although there are some data on sofosbuvir and ribavirin without interferon in HIV-infected persons with 76% or so cure rate (lower cure rate than when used WITH interferon). They were not approved for use with each other, although the combination you are taking looks most promising in certain situtations.

Perhaps you are in a study of this combination for people coinfected with HIV? If so I consider this a good thing, and smart experts have evaluated your HIV medications and potential interactions with simeprevir, and to see if you are able to take simeprevir based on your genetics (more below about this). If you are not in a clinical trial, I would have some questions to consider with your doctor.

There are data on the combination you are taking -- again, an exciting combination because we do not have to take interferon. An interim analysis from the COSMOS study was presented by Ira Jacobson MD at the Liver Meeting (AASLD)in November 2013 in Washington, DC (Abstract LB-3). Cure rates ranged from about 79%-96%. The study was done among persons with hep C alone, without HIV. However to date, cure rates and safety look basically the same in people with and without HIV -- with the caveat that there are drug-drug interactions between some HIV meds and simeprevir.

I would talk with your doctor about a few things. First, there are drug-drug interactions between simpeprevir and some HIV meds.

Second, there is a potential concern that simeprevir does not work in some persons with genotype 1a. There is a reduction in its effectiveness in genotype 1a patients with the Q80K polymorphism, a strain of hep C commonly found in U.S. (50% of genotype 1a persons, lower percentage of European persons with this genotype). The Q80K polymorphism is a naturally occurring variation in the HCV NS3/4A protease enzyme -- something a person inherits, like eye color -- this is genetic. We MUST screen for presence of this strain prior to therapy with simpeprevir and should NOT use simeprevir if this straing of hep C is detected.

It is good that you are working with a doctor who wants to cure your hep C. Getting cured when we have stage 3 is a good thing. I hope this happens for you now. If not, there are many new options which will soon be available in parts of the world where HIV-infected persons can access the meds you are currently taking.

Last, try to NEVER miss a hep C pill -- set a timer or watch, make a specific plan for adherence -- this will increase your chance of cure.

All best to you.



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