Direct-acting Antiviral Interactions With Opioids, Alcohol or Illicit Drugs of Abuse in HCV-infected Patients

Kuntheavy Ing Lorenzini; François Girardin


Liver International. 2020;40(1):32-44. 

In This Article


The HCV prevalence is significantly elevated in detainees, patients with severe mental illness and PWID. Marginalized populations represent key clusters and reservoir with high dynamic interindividual BBV transmission. These populations further consume a wide range of medications and illicit drugs. Efficacy and safety are paramount during the prescription of DAA. Based on our literature review with PK and PD consideration, the interaction potential of DAA with most opioids and illicit drugs appears rather marginal. Taken together, most DAA mainly inhibit the transmembrane transporter P-gp and to a lesser extent the metabolizing enzyme subfamily CYP3A. Although, theoretically, interactions are plausible with opioids including methadone, these were not confirmed in PK studies. Large phase 3 and cohort studies did not show any clinically significant SVR decrease in PWID taking DAA.