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
- "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.
