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Summary of Recommendations for HIV/HCV-Coinfected Patients Who Are Being Treated for HCV
 

Recommendations Related to HCV Medication Interactions with HIV Antiretroviral Medications
Listed in order of level of evidence, then within group alphabetically.

 

  • Antiretroviral drug switches, when needed, should be done in collaboration with the HIV practitioner. For HIV antiretroviral and HCV direct-acting antiviral combinations not addressed below, expert consultation is recommended.
    Rating: Class I, Level A

     
  • Daclatasvir when used in combination with other antivirals:
  • Daclatasvir requires dose adjustment with ritonavir-boosted atazanavir (a decrease to 30 mg daily) and efavirenz or etravirine (an increase to 90 mg daily).
    Rating: Class IIa, Level B

     
  • Daily fixed-dose combination of elbasvir/grazoprevir:
  • Elbasvir/grazoprevir should be used with antiretroviral drugs with which it does not have clinically significant interactions: abacavir, emtricitabine, enfuvirtide, lamivudine, raltegravir, dolutegravir, rilpivirine, and tenofovir.
    Rating: Class IIa, Level B

     
  • Simeprevir when used in combination with other antivirals:
  • Simeprevir should be used with antiretroviral drugs with which it does not have clinically significant interactions: abacavir, emtricitabine, enfuvirtide, lamivudine, maraviroc, raltegravir, (and probably dolutegravir), rilpivirine, and tenofovir.
    Rating: Class IIa, Level B

     
  • Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg):
  • Sofosbuvir/velpatasvir can be used with most antiretrovirals, but not efavirenz or etravirine. Because velpatasvir increases tenofovir levels, when given as tenofovir disoproxil fumarate (TDF), concomitant use mandates consideration of renal function and should be avoided in those with eGFR below 60 mL/min. In patients with eGFR > 60 mL/min concomitant dosing of velpatasvir and TDF with ritonavir-boosted or cobicistat-boosted regimens did not result in renal toxicity in 56 subjects. Renal monitoring is recommended during the dosing period. Tenofovir alafenamide (TAF) may be an alternative to TDF during sofosbuvir/velpatasvir treatment for patients who take cobicistat or ritonavir as part of their antiretroviral therapy.
    Rating: Class IIa, Level B

     
  • Daily fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg):
  • Ledipasvir/sofosbuvir can be used with most antiretrovirals. Because ledipasvir increases tenofovir levels, when given as tenofovir disoproxil fumarate (TDF), concomitant use mandates consideration of estimated glomerular filtration rate (eGFR) and should be avoided in those with eGFR below 60 mL/min. Because potentiation of this effect occurs when TDF is used with ritonavir-boosted or cobicistat-boosted regimens, ledipasvir should be avoided with this combination (pending further data) unless antiretroviral regimen cannot be changed and the urgency of treatment is high. Tenofovir alafenamide (TAF) may be an alternative to TDF during ledipasvir/sofosbuvir treatment for patients who take cobicistat or ritonavir as part of their antiretroviral therapy.
    Rating: Class IIa, Level C

 

  • For combinations expected to increase tenofovir levels, baseline and ongoing assessment for tenofovir nephrotoxicity is recommended.
    Rating: Class IIa, Level C

     
  • Daily fixed-dose combination of paritaprevir (150 mg)/ritonavir (100 mg)/ombitasvir (25 mg) plus twice-daily dosed dasabuvir (250 mg) (paritaprevir/ritonavir/ombitasvir plus dasabuvir or PrOD):
  • Paritaprevir/ritonavir/ombitasvir plus dasabuvir should be used with antiretroviral drugs with which they do not have substantial interactions: atazanavir, dolutegravir, emtricitabine, enfuvirtide, lamivudine, raltegravir, and tenofovir.
     
  • The dose of ritonavir used for boosting of HIV protease inhibitors may need to be adjusted (or held) when administered with paritaprevir/ritonavir/ombitasvir plus dasabuvir and then restored when HCV treatment is completed. The HIV protease inhibitor should be administered at the same time as the fixed-dose HCV combination.

Rating: Class IIa, Level C

 

Recommended Regimens for HIV/HCV-Coinfected Individuals
Listed in order of level of evidence, then within group alphabetically.

 

Not Recommended

Regimens Not Recommended for Patients with HIV/HCV Coinfection

  • Antiretroviral treatment interruption to allow HCV therapy is Not Recommended.
    Rating: Class III, Level A

  • Elbasvir/grazoprevir should NOT be used with cobicistat, efavirenz, etravirine, nevirapine, or any HIV protease inhibitor.
    Rating: Class III, Level B

  • Sofosbuvir/velpatasvir should NOT be used with efavirenz, etravirine, or nevirapine.
    Rating: Class III, Level B
  • Sofosbuvir-based regimens should NOT be used with tipranavir.
    Rating: Class III, Level B

  • Paritaprevir/ritonavir/ombitasvir plus dasabuvir should NOT be used with darunavir, efavirenz, ritonavir-boosted lopinavir, ritonavir-boosted tipranavir, etravirine, nevirapine, cobicistat, or rilpivirine.
    Rating: Class III, Level B

  • Paritaprevir/ritonavir/ombitasvir with or without dasabuvir should NOT be used in HIV/HCV-coinfected individuals who are not taking antiretroviral therapy.
    Rating: Class III, Level B

     

  • Ribavirin should NOT be used with didanosine, stavudine, or zidovudine.
    Rating: Class III, Level B

     

  • Simeprevir should NOT be used with cobicistat, efavirenz, etravirine, nevirapine, or any HIV protease inhibitor.
    Rating: Class III, Level B

     

Regimens Not Recommended for Patients with HIV/HCV Coinfection

  • Treatment courses shorter than 12 weeks, such as the use of 8 weeks of ledipasvir/sofosbuvir.
    Rating: Class IIb, Level C

Changes made April 12, 2017.