*I don't believe this response from Dr. Bositis went through to the full
group, so we are re-sending. Dr. Bositis, I was not able to retrieve the
attachment referenced, so if you could send it to us directly
(aidsed@xxxxxxxxxx <aidsed@xxxxxxxxxx>) I can try to send itout to the
*Dr. Bositis' original message:*
I can't answer your first question, unfortunately, but will add anecdotally
that I have heard similar things about the whole re-treatment
question. I think that the rationale is that given the incredible efficacy
of these medications, at the population level it is more likely that
a person with risk factors for re-infection really is re-infected and not
that they failed treatment, so re-treating with the same agents may
make some sense though it does go against current guidelines.
I am intrigued about what others think re: the utility of resistance
testing in this setting; I know that the presence or absence of RAS
mutations does not influence treatment outcomes in patients who are
treatment, but is the same true for individuals who have failed
treatment and where those RASs were selected by exposure to the
medication? I found a very helpful review on HCV resistance
(attached if interested), and it looks like there is no clear answer to
that question, but that data on re-treatment with the same agents
after clear failure show that SVR rates are highly variable. That,
combined with the fact that NS5A resistance is common and appears
to persist for quite some time, in those rare instances where virologic
failure with an NS5A regimen occurs, is what has led to the current
recommendation to use multiple targeted DAA regimens (eg SOF/VEL/VOX).
All that to say that perhaps there is a role for post-tx resistance
testing in this setting, bc if it shows clear evidence of NS5A resistance,
be less comfortable re-treating with the same regimen?
Christopher M. Bositis, MD, AAHIVS (he/him)
Greater Lawrence Family Health Center
Lawrence, MA 01841
On Fri, Sep 10, 2021 at 8:14 AM Beiser, Marguerite <mbeiser@xxxxxxxxx>
hope you're well!
I am wondering if anyone on this list is doing HCV tx at CHA. Or if any of
you have contacts of HCV treaters at Cambridge Health Alliance. We're
trying to confirm a tx history for a patient here and cant get enough info
to figure out if he is a reinfection or a tx failure.
Thanks for your help.
ps- i am hearing from a number of treaters and some payers that they are
approaching retreatment and the failure vs reinfection eval in some
different ways from the standard guidelines... namely, retreating people as
if they were naive even if they can't rule out prior failure. have also
heard from at least one payer that they want resistance testing in this
case, even though my prior teaching has been that presence or absence of
RAS mutations is not particularly helpful to determine responsiveness...
both new ways of doing things could be potentially effective and certainly
would be cost-saving, but i can't find any data or recommendations to
If you have input or experience, or are aware of any data in this area,
could you please send to the group?
i've written the AASLD/IDSA guidelines committee to ask them to clarify
recommendations in this area, as well as around nonadherence and resumption
vs discontinuation, but havent heard anything.
thanks again 🙂
Marguerite Beiser, ANP-BC
Director of HCV Services
Boston Health Care for the Homeless Program
780 Albany St.
Boston, MA 02118
Answering Service 781-221-6565
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