Antiretroviral treatment in people with HIV–HCV coinfection

ART is now recommended for all people with HIV irrespective of CD4+ cell count.[99] HIV ART-naive people with HIV–HCV coinfection should have an ART regimen selected that will minimise drug–drug interactions with HCV medications and minimise potential liver toxicity. HIV should be controlled before HCV treatment, particularly in those with advanced HIV immunosuppression (CD4+ count, < 200 cells/mm3). HIV-related opportunistic infections should be treated before initiation of HCV treatment. Treatment of people with a CD4+ cell count greater than 500 cells/mm3 may be deferred until HCV treatment is completed, to avoid drug–drug interactions. ART should not be switched for people who are on a stable regimen unless an unavoidable and unmanageable drug–drug interaction is identified, because switching ART in HIV virologically suppressed patients has a risk of HIV virological failure.[100]