HIV-hepatitis C coinfection: Difference between revisions
From IDWiki
mNo edit summary |
(→) |
||
(5 intermediate revisions by the same user not shown) | |||
Line 1: | Line 1: | ||
+ | ==Management== |
||
− | = Principles = |
||
− | * |
+ | *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=== |
||
− | = Regimens = |
||
− | * |
+ | *Consult [https://www.hep-druginteractions.org/checker 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) |
||
+ | {| class="wikitable" |
||
− | = Further Reading = |
||
+ | ! !! !!LDV/SOF!!SOF/VEL!!ELB/GRZ!!GLE/PIB!!SOF/VEL/VOX |
||
+ | |- |
||
+ | | 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 |
||
− | * [https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/26/hcv-hiv "Considerations for Antiretroviral Use in Patients with Coinfections"], in ''Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV''. AIDSinfo. |
||
+ | *'''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 |
||
− | * [https://www.hcvguidelines.org/unique-populations/hiv-hcv "Patients With HIV/HCV Coinfection"], in ''HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C''. IDSA & AASLD. |
||
+ | |||
+ | ==Further Reading== |
||
+ | |||
+ | *[https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/26/hcv-hiv "Considerations for Antiretroviral Use in Patients with Coinfections"], in ''Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV''. AIDSinfo. |
||
+ | *[https://www.hcvguidelines.org/unique-populations/hiv-hcv "Patients With HIV/HCV Coinfection"], in ''HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C''. IDSA & AASLD. |
||
[[Category:HIV]] |
[[Category:HIV]] |
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
- "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.