HIV-hepatitis C coinfection: Difference between revisions

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==Management==
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= HIV-Hepatitis C (HCV) coinfection =
  
   
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*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 ==
  
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*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)
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**ABC/FTC/DTG (Triumeq)
   
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{| class="wikitable"
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* Consult [https://www.hep-druginteractions.org/checker HEP Drug Interactions checker]
  
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! !! !!LDV/SOF!!SOF/VEL!!ELB/GRZ!!GLE/PIB!!SOF/VEL/VOX
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* Be careful with Harvoni, which can increase levels of tenofovir, especially when GFR <60 mL/min
  
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|-
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| rowspan="3" |PI
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|[[ATV/r]]
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| style="background:yellow" |A
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| style="background:yellow" |A
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| style="background:red" |
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| style="background:red" |
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| style="background:red" |
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|-
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|[[DRV/r]]
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| style="background:yellow" |A
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| style="background:yellow" |A
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| style="background:red" |
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| style="background:red" |
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| style="background:yellow" |
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|-
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|[[LPR/r]]
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| style="background:yellow" |A,ND
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| style="background:yellow" |A
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| style="background:red" |
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| style="background:red" |
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| style="background:red" |ND
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|-
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| rowspan="4" |NNRTI
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|[[DOR]]
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| style="background:green" |
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| style="background:green" |ND
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| style="background:green" |
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| style="background:green" |ND
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| style="background:green" |ND
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|-
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|[[EFZ]]
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| style="background:green" |
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| style="background:red" |
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| style="background:red" |
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| style="background:red" |ND
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| style="background:red" |ND
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|-
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|[[RPV]]
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| style="background:green" |
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| style="background:green" |
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| style="background:green" |
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| style="background:green" |
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| style="background:green" |
  +
|-
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|[[ETR]]
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| style="background:green" |ND
  +
| style="background:red" |ND
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| style="background:red" |ND
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| style="background:red" |ND
  +
| style="background:red" |ND
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|-
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| rowspan="4" |INSTI
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|[[BIC]]
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| style="background:green" |
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| style="background:green" |ND
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| style="background:green" |ND
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| style="background:green" |ND
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| style="background:green" |
  +
|-
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|[[EVG/c]]
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| style="background:yellow" |C
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| style="background:yellow" |C
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| style="background:red" |
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| style="background:yellow" |
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| style="background:yellow" |C
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|-
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|[[DTG]]
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| style="background:green" |
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| style="background:green" |
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| style="background:green" |
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| style="background:green" |
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| style="background:green" |ND
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|-
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|[[RTG]]
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| style="background:green" |
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| style="background:green" |
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| style="background:green" |
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| style="background:green" |
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| style="background:green" |ND
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|-
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|EI
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|[[MVC]]
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| style="background:green" |ND
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| style="background:green" |ND
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| style="background:green" |ND
  +
| style="background:green" |ND
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| style="background:green" |ND
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|-
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| rowspan="5" |NRTI
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|[[ABC]]
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| style="background:green" |
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| style="background:green" |ND
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| style="background:green" |ND
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| style="background:green" |
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| style="background:green" |ND
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|-
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|[[FTC]]
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| style="background:green" |
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| style="background:green" |
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| style="background:green" |
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| style="background:green" |
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| style="background:green" |
  +
|-
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|[[3TC]]
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| style="background:green" |
  +
| style="background:green" |ND
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| style="background:green" |ND
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| style="background:green" |
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| style="background:green" |ND
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|-
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|[[TDF]]
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| style="background:yellow" |B,C
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| style="background:yellow" |B,C
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| style="background:green" |
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| style="background:green" |
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| style="background:yellow" |C,D
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|-
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|[[TAF]]
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| style="background:green" |D
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| style="background:green" |D
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| style="background:green" |ND
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| style="background:green" |
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| style="background:green" |D
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|}
   
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*'''Green''' = safe; '''yellow''' = dose change or close monitoring; '''red''' = avoid
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== Further Reading ==
  
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*'''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
   
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==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.
  
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*[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.
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[[Category:HIV]]
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[[Category:Hepatitis C]]

Latest revision as of 08:50, 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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