HIV-hepatitis C coinfection: Difference between revisions

Revision as of 12:47, 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 Harvoni, which can increase levels of tenofovir, especially when GFR <60 mL/min

		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: @@
-== 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 &lt;60 mL/min
+*Be careful with Harvoni, which can increase levels of tenofovir, especially when GFR &lt;60 mL/min
 {| 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" |
 |-
-| [[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: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" | ND
+| style="background:red" |ND
 |-
-| rowspan=4 | NNRTI
+| rowspan="4" |NNRTI
-| [[DOR]]
+|[[DOR]]
 | style="background:green" |
-| style="background:green" | ND
+| style="background:green" |ND
 | 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: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" |
 |-
-| [[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" | ND
+| style="background:green" |ND
-| style="background:green" | ND
+| style="background:green" |ND
-| style="background:green" | ND
+| style="background:green" |ND
 | 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: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" | ND
+| style="background:green" |ND
 |-
-| [[RTG]]
+|[[RTG]]
 | 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" | ND
+| style="background:green" |ND
-| style="background:green" | ND
+| style="background:green" |ND
 | 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" |
 |-
-| [[3TC]]
+|[[3TC]]
 | 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" | 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: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" | 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]]