Consensus recommendations for treatment of HCV in the setting of HIV coinfection

Consensus recommendationsGrade
People with HCV–HIV coinfection should be cared for by a clinician who is experienced in managing both viral infections.B1
All people living with HCV should be tested for HIV.A1
All HCV-negative people living with HIV should be tested for HCV annually if they have risk factors for HCV exposure.A1
HIV should be controlled before HCV treatment.B1
ART should not be switched for people who are on a stable regimen, unless an unavoidable and unmanageable drug–drug interaction is identified.B1
The treatment regimens for chronic HCV infection in people living with HIV should be the same as those used for HCV mono-infection, because DAA regimens for the treatment of HCV are just as effective in the setting of HIV coinfection. However, cirrhosis and advanced fibrosis should be excluded by transient elastography or other imaging modality before use of an 8-week regimen of sofosbuvir–ledipasvir in people with Gt 1 HCV infection.B1
A careful assessment of potential drug–drug interactions between DAAs and ART and drugs prescribed to manage HIV-related complications and comorbidities should be performed and used to guide the selection of an appropriate DAA regimen for HCV.A1
HIV-positive individuals who achieve SVR after DAA therapy and who remain at risk of reinfection with HCV should continue to be screened with annual HCV RNA PCR and 3–6-monthly liver function test monitoring.C2

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