Use of Contraindicated Antiretroviral Drugs in People With HIV/HCV Coinfections Receiving HCV Treatment With Direct-Acting Antivirals

Results From the EuroSIDA Study

Myroslava Nikolaichuk; Amanda Mocroft; Gilles Wandeler; János Szlavik; Magnus Gottfredsson; Dag Henrik Reikvam; Veronica Svedhem; Hila Elinav; Montserrat Laguno; Kamal Mansinho; Emma Devitt; Nikoloz Chkhartishvili; Georg Behrens; Johannes Bogner; Jean-Paul Viard; Alan Winston; Thomas Benfield; Clifford Leen; Olga Fursa; Jürgen Rockstroh; Lars Peters


HIV Medicine. 2023;24(2):224-230. 

In This Article

Abstract and Introduction


Objectives: Our objective was to determine whether antiretroviral drugs (ARVs) were used according to the European AIDS Clinical Society (EACS) guidelines for people with HIV/hepatitis C virus (HCV) coinfection treated with direct-acting antivirals (DAAs) between 30 November 2014 and 31 December 2019 in the pan-European EuroSIDA study.

Methods: At each publication date of the EACS guidelines, plus 3 and 6 months, we calculated the number of people receiving DAAs with potential and actual ARV contraindications ('red shading' in the EACS guidelines). We used logistic regression to investigate factors associated with using contraindicated ARVs.

Results: Among 1406 people starting DAAs, the median age was 51 years, 75% were male, 57% reported injected drug use as an HIV risk, and 76% were from western Europe. Of 1624 treatment episodes, 609 (37.5%) occurred while the patient was receiving ARVs with potential contraindications; among them, 38 (6.2%; 95% confidence interval [CI] 4.3–8.2) involved a contraindicated ARV (18 non-nucleoside reverse transcriptase inhibitors), 16 involved protease inhibitors, and four involved integrase strand transfer inhibitors. The adjusted odds of receiving a contraindicated ARV were higher (3.25; 95% CI 1.40–7.57) among participants from east/central east Europe (vs. south) and lower (0.22; 95% CI 0.08–0.65) for 2015–2018 guidelines (vs. 2014). In total, 29 of the 32 (90.6%) patients receiving a contraindicated ARV and 441 of the 461 (95.7%) with potential ARV contraindications experienced a sustained virological response ≥12 weeks after stopping treatment (SVR12; p = 0.55).

Conclusion: In this large heterogenous European cohort, more than one-third of people with HIV/HCV coinfection received DAAs with potential ARV contraindications, but few received a contraindicated ARV. Use of contraindicated ARVs declined over time, corresponding to the increased availability of ARV therapy regimens without interactions with DAA across Europe. Participants who received a contraindicated DAA and ARV combination still had a high rate of SVR12.


Modern direct-acting antiviral (DAA) therapy is associated with high rates of cure among people with hepatitis C virus (HCV) infection, including those co-infected with HIV. Patients with HIV/HCV co-infection can be treated with the same DAA regimens as those with HCV mono-infection.[1]

However, potential drug–drug interactions between HCV and HIV medications, as well as with other commonly prescribed medications, including statins and proton pump inhibitors, requires consideration prior to initiation of DAA therapy to prevent adverse effects and treatment failure.[2,3] In most cases, drug interactions can be managed and are not a barrier for achieving HCV cure ( A study from the Dutch ATHENA cohort in 2017 showed that, among 49 individuals receiving a contraindicated antiretroviral (ARV) regimen prior to initiation of DAA therapy, only two (4%) continued these contraindicated regimens during DAA therapy.[4] So far, no data have been published from more heterogenous populations, including Eastern Europe, where both HIV and DAA treatment options are more limited.[5,6]

The aims of this study were to determine whether ARVs were used according to the European AIDS Clinical Society (EACS) guidelines for DAA therapy of HIV/HCV coinfection in the pan-European EuroSIDA study, and to compare the rate of sustained virological response (SVR) between those who received a contraindicated DAA/ARV combination and those receiving drugs that were not contraindicated.