HIV-hepatitis C coinfection: Difference between revisions

Latest revision as of 12:50, 13 August 2020

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

"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.

@@ Line 1: / Line 1: @@
+==Management==
-= HIV-Hepatitis C (HCV) coinfection =
+*Confirm both diagnoses, including ensuring HCV RNA is still positive 6 months after first measured
-== Principles ==
+*Treat the HIV first, using any first-line regimen
+*Treat the HIV for at least 2 weeks before starting HCV treatment
+===Choice of Antivirals===
-* 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 [https://www.hep-druginteractions.org/checker HEP Drug Interactions checker]
-== Regimens ==
+*Be careful with [[sofosbuvir]], which can increase levels of tenofovir, [[especially]] when GFR &lt;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)
+{| class="wikitable"
-* Consult [https://www.hep-druginteractions.org/checker HEP Drug Interactions checker]
+! !! !!LDV/SOF!!SOF/VEL!!ELB/GRZ!!GLE/PIB!!SOF/VEL/VOX
-* Be careful with Harvoni, which can increase levels of tenofovir, especially when GFR &lt;60 mL/min
+|-
+| rowspan="3" |PI
+|[[ATV/r]]
+| style="background:yellow" |A
+| style="background:yellow" |A
+| style="background:red" |
+| style="background:red" |
+| style="background:red" |
+|-
+|[[DRV/r]]
+| style="background:yellow" |A
+| style="background:yellow" |A
+| style="background:red" |
+| style="background:red" |
+| style="background:yellow" |
+|-
+|[[LPR/r]]
+| style="background:yellow" |A,ND
+| style="background:yellow" |A
+| style="background:red" |
+| style="background:red" |
+| style="background:red" |ND
+|-
+| rowspan="4" |NNRTI
+|[[DOR]]
+| style="background:green" |
+| style="background:green" |ND
+| style="background:green" |
+| style="background:green" |ND
+| style="background:green" |ND
+|-
+|[[EFZ]]
+| style="background:green" |
+| style="background:red" |
+| style="background:red" |
+| style="background:red" |ND
+| style="background:red" |ND
+|-
+|[[RPV]]
+| style="background:green" |
+| style="background:green" |
+| style="background:green" |
+| style="background:green" |
+| style="background:green" |
+|-
+|[[ETR]]
+| style="background:green" |ND
+| style="background:red" |ND
+| style="background:red" |ND
+| style="background:red" |ND
+| style="background:red" |ND
+|-
+| rowspan="4" |INSTI
+|[[BIC]]
+| style="background:green" |
+| style="background:green" |ND
+| style="background:green" |ND
+| style="background:green" |ND
+| style="background:green" |
+|-
+|[[EVG/c]]
+| style="background:yellow" |C
+| style="background:yellow" |C
+| style="background:red" |
+| style="background:yellow" |
+| style="background:yellow" |C
+|-
+|[[DTG]]
+| style="background:green" |
+| style="background:green" |
+| style="background:green" |
+| style="background:green" |
+| style="background:green" |ND
+|-
+|[[RTG]]
+| style="background:green" |
+| style="background:green" |
+| style="background:green" |
+| style="background:green" |
+| style="background:green" |ND
+|-
+|EI
+|[[MVC]]
+| style="background:green" |ND
+| style="background:green" |ND
+| style="background:green" |ND
+| style="background:green" |ND
+| style="background:green" |ND
+|-
+| rowspan="5" |NRTI
+|[[ABC]]
+| style="background:green" |
+| style="background:green" |ND
+| style="background:green" |ND
+| style="background:green" |
+| style="background:green" |ND
+|-
+|[[FTC]]
+| style="background:green" |
+| style="background:green" |
+| style="background:green" |
+| style="background:green" |
+| style="background:green" |
+|-
+|[[3TC]]
+| style="background:green" |
+| style="background:green" |ND
+| style="background:green" |ND
+| style="background:green" |
+| style="background:green" |ND
+|-
+|[[TDF]]
+| style="background:yellow" |B,C
+| style="background:yellow" |B,C
+| style="background:green" |
+| style="background:green" |
+| style="background:yellow" |C,D
+|-
+|[[TAF]]
+| style="background:green" |D
+| style="background:green" |D
+| style="background:green" |ND
+| style="background:green" |
+| style="background:green" |D
+|}
+*'''Green''' = safe; '''yellow''' = dose change or close monitoring; '''red''' = avoid
-== Further Reading ==
+*'''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==
-* [https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/26/hcv-hiv &quot;Considerations for Antiretroviral Use in Patients with Coinfections&quot;], in ''Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV''. AIDSinfo.
-* [https://www.hcvguidelines.org/unique-populations/hiv-hcv &quot;Patients With HIV/HCV Coinfection&quot;], in ''HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C''. IDSA &amp; AASLD.
+*[https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/26/hcv-hiv &quot;Considerations for Antiretroviral Use in Patients with Coinfections&quot;], in ''Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV''. AIDSinfo.
+*[https://www.hcvguidelines.org/unique-populations/hiv-hcv &quot;Patients With HIV/HCV Coinfection&quot;], in ''HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C''. IDSA &amp; AASLD.
+[[Category:HIV]]
+[[Category:Hepatitis C]]