By: Marcus J. Hopkins, Blogger
I had my semi-annual appointment with my Infectious Disease doctor, last week, and during my visit, we took a few moments to talk about the state and amazing progress of the HCV treatment regimens. When I asked him about how Zepatier was working out for him, and he was pretty straightforward:
“It works great, if you can find anyone whose current drug regimens don’t interact with it.”
Being the HCV drug nerd that I’ve become, I decided to look into his complaint, and what I came away with isn’t promising. Most of the newer HIV combination therapies contain at least one component that essentially prevents a patient from safely taking Zepatier as a cure for HCV. This troubles me, as Merck, the maker of Zepatier, had really impressed me by introducing an effective HCV drug at a comparatively affordable price point – $54,000 Wholesale Acquisition Cost (WAC), to Harvoni’s (Gilead) $94,000k. While that lower price point is great, for people co-infected with HIV, those savings are unlikely to be realized.
I decided to compare the seven currently available DAA HCV drugs with my current regimen – Gilead’s very popular and effective Stribild – and what I walked away with was, “I’d better not get HCV.” Of the four individual components in Stribild – elvitegravir, cobicistat, emtricitabine, and tenofovir – at least one of those components had a negative drug interaction with six of the seven HCV drugs. The only drug that showed no counterindication was Gilead’s Sovaldi. Even then, there’s a risk of counterindication, because Sovaldi needs to be paired with either Olysio or Ribavirin to be truly effective against HCV, both of which have a potentially negative interaction with one of the component drugs.
What this would mean, for me, was the need to use ribavirin in order to avoid a serious interaction, but even then, there’s a high potential for a mild interaction. Essentially, I would have to switch drug regimens for HIV prior to treating HCV, which can be a bad thing for someone whose regimen has been working well to keep their HIV virally suppressed. While achieving a “cure” for HCV can take less than a year, with twelve weeks being the current standard duration, that year can be difficult if the new HIV regimen has adverse side effects.
For those interested in figuring out which HCV treatment would be right for you in conjunction with your current HIV regimen, I highly suggest the following resource: HEP Drug Interactions. This site is an easy to use project of the University of Liverpool, in Liverpool, England. You use the left column to select the various HCV treatments, and the right column to find whichever drugs you take that may have a counterindication. This is an invaluable tool, and can be a lifesaver.
Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.