HCV treatment in people with HIV–HCV coinfection

The treatment regimens for HCV in people with HIV are the same as those used for HCV mono-infection and, as noted, the response rates are equivalent. [90-95],[101] Selection of DAA therapy for people with HIV–HCV coinfection should be as for HCV mono-infection, with the important caveat that ART increases the likelihood of clinically significant drug–drug interactions. A careful assessment of potential drug–drug interactions between DAAs and ART and drugs prescribed to manage HIV-related complications and comorbidities should be made before commencing HCV treatment, using the University of Liverpool’s Hepatitis Drug Interactions website.

Caution is warranted even for combinations of HIV ART and HCV DAAs where a specific drug–drug interaction issue is not expected or reported, as further information on interactions is likely to emerge. Due to extensive drug–drug interactions, tipranavir should be avoided with concurrent HCV DAA therapy. Caution should also be exercised in selecting the 8-week regimen of sofosbuvir–ledipasvir for individuals with Gt 1 HCV and HIV coinfection and an HCV viral load less than 6 000 000 IU/mL due to the lack of high-quality efficacy data in this population; cirrhosis and advanced fibrosis should be definitively ruled out using transient elastography before selecting this regimen.