HIV-hepatitis C coinfection: Difference between revisions

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== Principles ==
==Management==


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


===Choice of Antivirals===
== Regimens ==


* Consult [https://www.hep-druginteractions.org/checker HEP Drug Interactions checker]
*Consult [https://www.hep-druginteractions.org/checker HEP Drug Interactions checker]
* Be careful with Harvoni, which can increase levels of tenofovir, especially when GFR <60 mL/min
*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)


{| class="wikitable"
{| class="wikitable"
! !! !! LDV/SOF !! SOF/VEL !! ELB/GRZ !! GLE/PIB !! SOF/VEL/VOX
! !! !!LDV/SOF!!SOF/VEL!!ELB/GRZ!!GLE/PIB!!SOF/VEL/VOX
|-
|-
| rowspan = 3 | PI
| rowspan="3" |PI
| [[ATV/r]]
|[[ATV/r]]
| style="background:yellow" | A
| style="background:yellow" |A
| style="background:yellow" | A
| style="background:yellow" |A
| style="background:red" |
| style="background:red" |
| style="background:red" |
| style="background:red" |
| style="background:red" |
| style="background:red" |
|-
|-
| [[DRV/r]]
|[[DRV/r]]
| style="background:yellow" | A
| style="background:yellow" |A
| style="background:yellow" | A
| style="background:yellow" |A
| style="background:red" |
| style="background:red" |
| style="background:red" |
| style="background:red" |
| style="background:yellow" |
| style="background:yellow" |
|-
|-
| [[LPR/r]]
|[[LPR/r]]
| style="background:yellow" | A,ND
| style="background:yellow" |A,ND
| style="background:yellow" | A
| style="background:yellow" |A
| style="background:red" |
| style="background:red" |
| style="background:red" |
| style="background:red" |
| style="background:red" | ND
| style="background:red" |ND
|-
|-
| rowspan=4 | NNRTI
| rowspan="4" |NNRTI
| [[DOR]]
|[[DOR]]
| style="background:green" |
| style="background:green" |
| style="background:green" | ND
| style="background:green" |ND
| style="background:green" |
| style="background:green" |
| style="background:green" | ND
| style="background:green" |ND
| style="background:green" | ND
| style="background:green" |ND
|-
|-
| [[EFZ]]
|[[EFZ]]
| style="background:green" |
| style="background:green" |
| style="background:red" |
| style="background:red" |
| style="background:red" |
| style="background:red" |
| style="background:red" | ND
| style="background:red" |ND
| style="background:red" | ND
| style="background:red" |ND
|-
|-
| [[RPV]]
|[[RPV]]
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
|-
|-
| [[ETR]]
|[[ETR]]
| style="background:green" | ND
| style="background:green" |ND
| style="background:red" | ND
| style="background:red" |ND
| style="background:red" | ND
| style="background:red" |ND
| style="background:red" | ND
| style="background:red" |ND
| style="background:red" | ND
| style="background:red" |ND
|-
|-
| rowspan=4 | INSTI
| rowspan="4" |INSTI
| [[BIC]]
|[[BIC]]
| style="background:green" |
| style="background:green" |
| style="background:green" | ND
| style="background:green" |ND
| style="background:green" | ND
| style="background:green" |ND
| style="background:green" | ND
| style="background:green" |ND
| style="background:green" |
| style="background:green" |
|-
|-
| [[EVG/c]]
|[[EVG/c]]
| style="background:yellow" | C
| style="background:yellow" |C
| style="background:yellow" | C
| style="background:yellow" |C
| style="background:red" |
| style="background:red" |
| style="background:yellow" |
| style="background:yellow" |
| style="background:yellow" | C
| style="background:yellow" |C
|-
|-
| [[DTG]]
|[[DTG]]
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" | ND
| style="background:green" |ND
|-
|-
| [[RTG]]
|[[RTG]]
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" | ND
| style="background:green" |ND
|-
|-
| EI
|EI
| [[MVC]]
|[[MVC]]
| style="background:green" | ND
| style="background:green" |ND
| style="background:green" | ND
| style="background:green" |ND
| style="background:green" | ND
| style="background:green" |ND
| style="background:green" | ND
| style="background:green" |ND
| style="background:green" | ND
| style="background:green" |ND
|-
|-
| rowspan=5 | NRTI
| rowspan="5" |NRTI
| [[ABC]]
|[[ABC]]
| style="background:green" |
| style="background:green" |
| style="background:green" | ND
| style="background:green" |ND
| style="background:green" | ND
| style="background:green" |ND
| style="background:green" |
| style="background:green" |
| style="background:green" | ND
| style="background:green" |ND
|-
|-
| [[FTC]]
|[[FTC]]
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
|-
|-
| [[3TC]]
|[[3TC]]
| style="background:green" |
| style="background:green" |
| style="background:green" | ND
| style="background:green" |ND
| style="background:green" | ND
| style="background:green" |ND
| style="background:green" |
| style="background:green" |
| style="background:green" | ND
| style="background:green" |ND
|-
|-
| [[TDF]]
|[[TDF]]
| style="background:yellow" | B,C
| style="background:yellow" |B,C
| style="background:yellow" | B,C
| style="background:yellow" |B,C
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:green" |
| style="background:yellow" | C,D
| style="background:yellow" |C,D
|-
|-
| [[TAF]]
|[[TAF]]
| style="background:green" | D
| style="background:green" |D
| style="background:green" | D
| style="background:green" |D
| style="background:green" | ND
| style="background:green" |ND
| style="background:green" |
| style="background:green" |
| style="background:green" | D
| style="background:green" |D
|}
|}


* '''Green''' = safe; '''yellow''' = dose change or close monitoring; '''red''' = avoid
*'''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
*'''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 ==
==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://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://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:HIV]]

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

Further Reading

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