HIV Co-Infection

HIV/HCV-coinfected persons should be treated and retreated the same as persons without HIV infection, after recognizing and managing interactions with antiretroviral medications

 

Daily daclatasvir (60 MG) plus sofosbuvir (400 mg), with or without ribavirin, is a recommended regimen when antiretroviral regimen changes cannot be made to accommodate alternative HCV direct-acting antivirals

 

Ledipasvir/sofosbuvir for 8 weeks is not recommended, regardless of baseline HCV RNA level.

 

HARVONI

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.

RIBAVIRIN

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

DACLATASVIR

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

 

 

ZEPATIER

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.

Elbasvir/grazoprevir should not be used with cobicistat, efavirenz, etravirine, nevirapine, or any HIV protease inhibitor.

EPCLUSA

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.

MAVYRET

Daily fixed-dose combination of glecaprevir (300 mg)/pibrentasvir (120 mg)

Glecaprevir/pibrentasvir should be used with antiretroviral drugs with which it does not have clinically significant interactions: abacavir, emtricitabine, enfuvirtide, lamivudine, raltegravir, dolutegravir, rilpivirine, and tenofovir.
Given the limited data on the safety of elvitegravir/cobicistat with glecaprevir/pibrentasvir, monitoring for hepatic toxicity is recommended until additional safety data are available in HIV/HCV-coinfected patients.

Glecaprevir/pibrentasvir should not be used with atazanavir, ritonavir-containing antiretroviral regimens, efavirenz, or etravirine.

VOSEVI

Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg)/voxilaprevir (100 mg) Sofosbuvir/velpatasvir/voxilaprevir should be used with antiretroviral drugs with which they do not have substantial interactions: dolutegravir, emtricitabine, enfuvirtide, lamivudine, rilpivirine, and raltegravir.
Given increases in voxilaprevir AUC with darunavir/ritonavir or elvitegravir/cobicistat coadministration and lack of clinical safety data, monitoring for hepatic toxicity is recommended until additional safety data are available in HIV/HCV-coinfected patients.
Because this therapy has the potential to increase tenofovir levels when given as tenofovir disoproxil fumarate, concomitant use mandates consideration of renal function and should be avoided in those with an eGFR <60 mL/min. In patients receiving sofosbuvir/velpatasvir/voxilaprevir and tenofovir disoproxil fumarate concomitantly, renal monitoring is recommended during the dosing period.

Sofosbuvir/velpatasvir/voxilaprevir should not be used with ritonavir-boosted atazanavir, efavirenz, etravirine, or nevirapine.

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