What are considerations when treating coexisting HIV and HCV infections?

Updated: May 07, 2020
  • Author: Shirin A Mazumder, MD, FIDSA; Chief Editor: Michelle R Salvaggio, MD, FACP  more...
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Patients receiving or considering therapy with ribavirin should avoid didanosine, stavudine, and zidovudine.

Use caution with antiretroviral agents with the greatest risk of DILI (eg, nevirapine).

Assess cirrhotic patients for signs of liver decompensation according to the Child-Turcotte-Pugh classification system; hepatically metabolized antiretroviral drugs may require dose modification or avoidance in patients with Child-Pugh class B and C disease. [6]

Treatment of both HCV and HIV can be complicated by drug interactions, drug toxicities, and pill burden. Many of the newer directly acting anti-HCV drugs have significant interactions with antiretroviral agents; however, ledipasvir with sofosbuvir and daclatasvir plus sofosbuvir have been demonstrated as efficacious. [24, 25]

Regimen selection for HCV infection can vary based on genotype, history of prior HCV treatment, stage of underlying liver fibrosis, and, in rare cases, the presence of baseline NS5A inhibitor resistance–associated substitutions.

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