HIV-hepatitis C coinfection

From IDWiki

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

Choice of Antivirals

  • 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

Further Reading