We receive emails from people with hepatitis C from all over the world and they wish to receive the new antiviral drugs at reasonable costs. This is now available from Australia and for many sufferers is a dream come true. Several Australian compounding pharmacies can provide these new anti-viral drugs from Australia through doctors and administrators who provide prescriptions to the pharmacists. The patients are monitored by their own local doctors who order and review their blood tests. These are generic versions of the new anti-viral drugs and are made in India under license from the parent companies and imported into Australia. The cost varies from $1600.00 to $2400.00 Australian dollars. In Australia, the new drugs are available to all patients who test positive for infection with the HCV and these drugs are fully subsidized by the government. This is not the case in most other countries and the drugs remain too expensive for most people. In Australia, there is a policy that there is no urgency to treat people with HCV who have only mild liver disease but the vast majority of people want to be treated anyway, and I can understand why. All patients should be tested for cirrhosis with a fibroscan test and blood tests and those with cirrhosis should be treated by a specialist. In Australia patients without cirrhosis can be treated with the new drugs by family doctors (general practitioners). The biggest breakthrough was the discovery of a drug called Sofosbuvir which binds to the most potent region of the Hepatitis C Virus (HCV) needed for the virus to replicate. Sofosbuvir was potent, effective and the HCV did not appear to develop resistance to it. Unfortunately, although Sofosbuvir suppressed the HCV in more than 50% of patients while they stayed on it, the HCV resurfaced and came back when the drug was stopped. So used alone Sofosbuvir was not potent enough so other new drugs had to be developed against other parts of the HCV to stop it replicating. The combination of these other drugs with Sofosbuvir not only suppressed the HCV but also stopped the HCV from coming back in over 90% of patients. You still need to be careful and look after your health as the new drug combinations do not give you immunity against the HCV and you can acquire a new infection. So if you contracted a new infection with the same HCV via intravenous drug use or non-sterile medical equipment, you have a high chance of being reinfected. Will everyone treated with the new drugs be cured? There are some people who don’t get a 90% cure rate but they are a minority and are often patients with liver failure who have the genotype 3 form of the HCV. In such patients the drug combinations have a lower cure rate of 65% on average. However, in genotype 3 patients who have good liver function and no cirrhosis, they still have a 90% cure rate. What drug combinations are recommended? Genotype 1 Treatment Naïve (never been treated) patients with no cirrhosis Ledipasvir and Sofosbuvir (Harvoni) for 12 weeks Or Daclatasvir and Sofosbuvir (Solvadi) for 12 weeks If cirrhosis is present treatment lasts for 24 weeks Genotype 2 Treatment Naïve patients with no cirrhosis Sofosbuvir and Ribavirin for 12 weeks If cirrhosis is present treatment lasts for 24 weeks Genotype 3 Treatment Naïve patients with no cirrhosis Daclatasvir and Sofosbuvir for 12 weeks If cirrhosis is present treatment lasts for 24 weeks Genotype 4, 5 and 6 Interferon, Ribavirin and Sofosbuvir but this may change in the near future To check for drug interactions with other medications see www.hep-druginteractions.org When should the patient be tested for a cure? Three months after the end of treatment a blood test should be done to detect the HCV (viral RNA). If they still test positive this means their HCV is resistant to the other drugs but not to Sofosbuvir. In such cases there are no new drugs to treat the resistant HCV, but newer drugs being developed are likely to be effective against resistant strains of the HCV. If you do not get a cure you can wait to go into a clinical trial of these new drugs to see if you can be cured but these drugs are not yet government subsidized. For more information, contact Mr Gregory Jefferies at [email protected] and see the website http://hepatitisctreatment.homestead.com/