HIV Co-Infection

HIV-1/HCV Co-infected patients should be prescribed the recommended regimen for mono-infected G1-6 chronic HCV patients  

  1. G1a/1b
    1. Viekira Pak [Paritaprevir/r + Ombitasvir daily fixed dose combination + Dasabuvir twice daily dose + RBV WBD BID] [with food] for 12 weeks –> 91% SVR12 (G1a) to 100% SVR12 (G1b) [Turquoise I]
    2. Harvoni [LDV/SOF daily fixed dose combination] 1 tab daily for 12 weeks –> 98% SVR12 (ERADICATE) & 96% SVR12; 97% [Treatment Experienced]; 94% [Cirrhosis] (ION-4)
    3. G1a: SOF 400mg QD + RBV 1000-1200mg BID for 24 weeks –> 82% SVR12 (PHOTON-1 & 2)
    4. G1b: SOF 400mg QD + RBV 1000-1200mg BID for 24 weeks –>> 54-81% SVR12 (PHOTON-1 & 2)
    5. Zepatier [Elbasvir and Grazoprevir fixed dose combination] 1 tab daily for 12-16 weeks [HIV/HCV-coinfected persons should be treated and retreated the same as persons without HIV infection] –> 96% SVR12 (C-EDGE)
    6. Epclusa [VEL/SOF daily fixed dose combination] 1 tab daily for 12 weeks –> 95% SVR12 (Wyles EASL 2016)

 

  1. G2 naïve NON-CIRRHOTIC
    1. Epclusa [VEL/SOF daily fixed dose combination] 1 tab daily for 12 weeks –> 95% SVR12 (Wyles EASL 2016)

 

  1. G3 & G4 naive NON-CIRRHOTIC
    1. Epclusa [VEL/SOF daily fixed dose combination] 1 tab daily for 12 weeks –> 95% SVR12 (Wyles EASL 2016)

 

  1.        G1 – G4 naive NON-CIRRHOTIC
  1. SOF 400mg QD + DCV 60mg daily for 12 weeks –> 97% SVR12 (ALLY-2, Wyles Heptology 2015)

 

 

      

  1. G1 – G4 naive COMPENSATED CIRRHOTIC
  2. SOF 400mg QD + DCV 60mg daily for 12 weeks –> 60% SVR12 (ALLY-2, Wyles Heptology 2015)

##Concomitant use of a boosted Darunavir-based antiretroviral regimen with 30 mg DCV –     67% SVR12

  1. G1, G4-G6 – prior treatment failure to SOF + PEG + RBV or SOF + RBV
  2. Non-cirrhotic: SOF 400mg QD + LDV 90mg daily for+ RBV WBD BID 12 weeks
  3. Cirrhotic: SOF 400mg QD + LDV 90mg daily for+ RBV WBD BID 24 weeks
  4. G1-G6 – prior treatment failure to SOF + PEG + RBV or SOF + RBV
  5. Non-cirrhotic: SOF 400mg QD + DCV 60mg daily for+ RBV WBD BID 12 weeks
  6. Cirrhotic: SOF 400mg QD + DCV 60mg daily for+ RBV WBD BID 24 weeks

 

 

 

Clinic Visits & Labs                                                                                                                      

  1. Initiation of Therapy
  2. Week 2 – CBC, CMP
  3. Week 4 – CBC, CMP, HCV RNA PCR quantitative [hCG with RBV]
  4. Week 8 – CBC, CMP
  5. Week 12 – CBC, CMP, HCV RNA PCR quantitative [hCG with RBV]
  6. Week 4 Post Therapy – CBC, CMP, HCV RNA PCR quantitative [hCG with RBV]
  7. Week 12 Post Therapy – CBC, CMP, HCV RNA PCR quantitative [hCG with RBV] – SVR12

*** 24 weeks duration therapy

  • Monthly labs after week 12 – CBC & CMP
  • Week 24 HCV RNA PCR quantitative [hCG with RBV]

 

 

Viekira Pak = Paritaprevir [150 mg]/r [100 mg] (NS3/4A protease inhibitor + ritonavir) + Ombitasvir [25 mg] (NS5A inhibitor) + Dasabuvir [250 mg] (non-nucleoside NS5B polymerase inhibitor) ± RBV WBD

SOF = Sofosbuvir [Solvaldi] – NS5B nucleotide analog polymerase inhibitor

LDV = Ledipasvir [90 mg daily] – NS5A inhibitor

VEL = Velpatasvir [100 mg daily] – NS5A inhibitor

DCV = Daclatasvir [60 mg daily] – NS5A inhibitor

RBV = Ribavirin [RIBAPAK/MODERIBA/RIBAVIRIN] [Weight <75 kg – 1000 mg daily; >75 kg – 1200 mg daily]

Zepatier = Elbasvir [50 mg] – NS5A inhibitor + Grazoprevir [100 mg daily] – NS3/4A protease inhibitor

* Harvoni [LDV/SOF daily fixed dose combination] SHOULD NOT be used with Cobicistat, Elvitegravir or Tipranavir. Because ledipasvir increases tenofovir levels, when given as tenofovir disoproxil fumarate (TDF), concomitant use mandates consideration of creatinine clearance (CrCl) rate and should be avoided in those with CrCl below 60 mL/min

** Viekira Pak [Paritaprevir/r + Ombitasvir daily fixed dose combination + Dasabuvir twice daily dose SHOULD NOT be used with Efavirenz, Rilpivirine, Darunavir, or Ritonavir-boosted Lopinavir

***RBV SHOULD NOT be used with Didanosine, Stavudine or Zidovudine

**** Daclatasvir requires dose adjustment with ritonavir-boosted atazanavir (a decrease to 30 mg daily) and efavirenz or etravirine (an increase to 90 mg daily)

***** 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

***** 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 CrCl below 60 mL/min. In patients with CrCl > 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

 

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