HIV-hepatitis C coinfection

Management

Confirm both diagnoses, including ensuring HCV RNA is still positive 6 months after first measured
Treat the HIV first, using any first-line regimen
Treat the HIV for at least 2 weeks before starting HCV treatment

Consult HEP Drug Interactions checker
Be careful with sofosbuvir, which can increase levels of tenofovir, especially when GFR <60 mL/min
In general, a first-line INSTI-based regimen that avoids TDF is the safest
- TAF/3TC + (RTG or DTG)
- ABC/FTC/DTG (Triumeq)

		LDV/SOF	SOF/VEL	ELB/GRZ	GLE/PIB	SOF/VEL/VOX
PI	ATV/r	A	A
	DRV/r	A	A
	LPR/r	A,ND	A			ND
NNRTI	DOR		ND		ND	ND
	EFZ				ND	ND
	RPV
	ETR	ND	ND	ND	ND	ND
INSTI	BIC		ND	ND	ND
	EVG/c	C	C			C
	DTG					ND
	RTG					ND
EI	MVC	ND	ND	ND	ND	ND
NRTI	ABC		ND	ND		ND
	FTC
	3TC		ND	ND		ND
	TDF	B,C	B,C			C,D
	TAF	D	D	ND		D

Green = safe; yellow = dose change or close monitoring; red = avoid
ND = no data; A = caution with TDF only; B = increase in tenofovir possible; C = avoid TDF with eGFR < 60 mL/min; D = studied in fixed-dose combinations only

"Considerations for Antiretroviral Use in Patients with Coinfections", in Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. AIDSinfo.
"Patients With HIV/HCV Coinfection", in HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C. IDSA & AASLD.