Skip to main content
SpringerLink
Log in

Drug Interactions Associated with HIV and HCV Medications

  • Hepatitis C (K Marks, Section Editor)
  • Published:
Current Treatment Options in Infectious Diseases Aims and scope Submit manuscript

Opinion Statement

The management of HCV in the setting of HIV co-infection has been transformed with the availability of the direct-acting antivirals. Cure rates for HCV in co-infection are greater than 90 % in all genotypes. Even difficult to treat patients with cirrhosis can be successfully treated with newer regimens. Consensus guidelines are available to assist providers in selecting appropriate regimens. Despite their widespread success, drug interactions when combining HIV and HCV medications are complex, but manageable. In this review, an in-depth description of how DAAs and HIV medications are metabolized is provided. Specific guidance around combining DAA regimens with common HIV regimens used in the modern treatment era are reviewed in detail. Tables and figures contained in the review also highlight common interactions encountered with DAA/HIV combinations, route of metabolism, and compatibility for common HIV regimens when combined with DAAs. Providers are encouraged to utilize the information in this article as a guide for treating HIV and HCV co-infection for assistance in selecting regimens that are least likely to interact. Examples of peer reviewed, reputable web, and print references are also provided; these should be utilized prior to initiating therapy as screening tools to assist in managing HIV/DAA drug interactions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of Particular Interest, Published Recently, Have Been Highlighted as: • Of importance •• Of major importance

  1. Lawitz E, Sulkowski MS, Ghalib R, Rodriquez-Torres M, Younossi ZM, et al. Simeprevir plus sofosbuvir with or without ribavirin to treat chronic infection with hepatitis C virus genotype1 in non-responders to pegylated interferon and ribavirin and treatment naïve patients: the COSMOS randomized study. Lancet. 2014;384:1756–65. doi:10.1016/S0140-6736(14)61036-9.

    Article  CAS  PubMed  Google Scholar 

  2. Afdhal N, Zeuzem S, Kwo P, Chojkier M, Gitlin N, Puoti M, et al. Ledipasvir and sofosbuvir for untreated HCV genotype 1 infection. N Engl J Med. 2014;370:1889–98. doi:10.1056/NEJMoa1402454.

    Article  PubMed  Google Scholar 

  3. Afdhal N, Reddy R, Nelson D, Lawitz E, Gordon SC, et al. Ledipasvir and sofosbuvir for previously treated HCV genotype 1 infection. N Engl J Med. 2014;370:1483–93. doi:10.1056/NEJMoa1316366.

    Article  CAS  PubMed  Google Scholar 

  4. Kowdley KV, Gordon SC, Reddy R, Rossaro L, Bernstein DE, Lawitz E, et al. Ledipasvir and sofosbuvir for 8 or 12 weeks for chronic HCV without cirrhosis. N Engl J Med. 2014;370:1879–88. doi:10.1056/NEJMoa1402355.

    Article  PubMed  Google Scholar 

  5. Poordad F, Hezode C, Trinh R, et al. ABT-450/r-ombitasvir and dasabuvir with ribavirin for hepatitis C with cirrhosis. N Engl J Med. 2014;370:1973.

    Article  PubMed  Google Scholar 

  6. Sulkowski M, Hezode C, Gerstoft J, et al. Efficacy and safety of 8 weeks versus 12 weeks of treatment with grazoprevir (MK-5172) and elbasvir (MK-8742) with or without ribavirin in patients with hepatitis C virus genotype 1 mono-infection and HIV/hepatitis C virus co-infection (C-WORTHY): a randomised, open-label phase 2 trial. Lancet. 2015;385:1087. doi:10.1016/S0140-6736(14)61793-1.

    Article  CAS  PubMed  Google Scholar 

  7. Feld JJ, Jacobson IM, Hezode C, Asselah T, Ruane PJ, Gruener N, et al. Sofosbuvir and velpatasvir for HCV genotype 1,2,4,5 and 6 infection. N Engl J Med. 2015;373:2599–607. doi:10.1056/NEJMoa1512610.

    Article  CAS  PubMed  Google Scholar 

  8. Foster GR, Afdhal N, Roberts SK, et al. Sofosbuvir and velpatasvir for HCV genotype 2 and 3 infection. N Engl J Med. 2015;373:2608–17. doi:10.1056/NEJMoa1512612.

    Article  CAS  PubMed  Google Scholar 

  9. Curry MP, O’Leary JG, Bzowej N, Muir AJ, Korenblat KM, et al. Sofosbuvir and velpatasvir in patients with decompensated cirrhosis. N Engl J Med. 2015;373:2618–28. doi:10.1056/NEJMoa1512614.

    Article  CAS  PubMed  Google Scholar 

  10. Sulkowski MS, Gardiner DF, Rodriguez-Torres M, Reddy KR, Hassanein T, Jacobson I, et al. Daclatasvir plus sofosbuvir for previously treated or untreated chronic HCV infection. N Engl J Med. 2014;370(3):211–21. doi:10.1056/NEJMoa1306218.

    Article  CAS  PubMed  Google Scholar 

  11. •• Wyles DL, Ruane PJ, Sulkowski MS, Dietrich D, Luetkemeye A, Morgan TR, et al. Daclatasvir plus sofosbuvir for HCV in patients co-infected with HIV-1. N Engl J Med. 2015;373:714–25. doi:10.1056/NEJMoa1503153. Key reference demonstrating the efficacy of HCV direct acting antiviral regimen in patient coinfected with HIV and HCV.

    Article  CAS  PubMed  Google Scholar 

  12. •• Naggi S, Copper C, Saag M, Workowski K, Ruane P, Towner WJ, et al. Ledipasvir and sofosbuvir for HCV in patient coinfected with HIV-1. N Engl J Med. 2015;373:705–13. doi:10.1056/NEJMoa1501315. Key reference demonstrating the efficacy of HCV direct acting antiviral regimen in patient coinfected with HIV and HCV.

    Article  Google Scholar 

  13. •• Rockstroh JK, Nelson M, Katlama C, Lalezari J, Mallolas J, Bloch M, et al. Efficacy and safety of grazoprevir and elbasvir in patients with hepatitis c virus and hiv co-infection (C-EDGE CO-INFECTION): a non-randomized, open label trial. Lancet HIV. 2015;2:e319–27. doi:10.1016/S2532-3018(15)00114-9. Key reference demonstrating the efficacy of HCV direct acting antiviral regimen in patient coinfected with HIV and HCV.

    Article  PubMed  Google Scholar 

  14. •• Sulkowski MS, Eron JJ, Wyles D, Trinh R, Lalezari J, Wang C, et al. Ombitasvir, paritaprevir co-dosed with ritonavir, dasabuvir, and ribavirin for hepatitis C in patients co-infected with HIV-1: a randomized trial. JAMA. 2015;313(12):1223–31. doi:10.1001/jama.2015.1328. Key reference demonstrating the efficacy of HCV direct acting antiviral regimen in patient coinfected with HIV and HCV.

    Article  CAS  PubMed  Google Scholar 

  15. •• Wyles D, Brau N, Kottilil S, et al. Sofosbuvir and velpatasvir for 12 weeks in patients co-infected with HCV and HIV-1: the Astral-5 study. The International Liver Congress, 13–17 April 2017, Barcelona, Spain. Abstract PS-104. Key reference demonstrating the efficacy of HCV direct acting antiviral regimen in patient coinfected with HIV and HCV.

  16. Hansten PD. Drug interactions. In: Koda-Kimble MA, editor. Applied therapeutics: the clinical use of drugs. Vancouver: Applied Therapeutics, Inc.; 1995. p. 1–3.

    Google Scholar 

  17. Buxton ILO. Pharmacokinetics and Pharmacodynamics: The Dynamics of Drug Absorption, Distribution, Action, and Elimination. In: Brunton LL, ed. Goodman and Gilman’s The Pharmacologic Basis of Therapeutics. 11th ed. 2005:1–40.

  18. Department of Health and Human Services Guidelines for the Management of HIV Infection in Adults and Adolescents. Located at https://aidsinfo.nih.gov/guidelines. Accessed August 30, 2016.

  19. Gunthard HF, Saag MS, Benson CA, del Rio C, Eron JJ, Gallant JE, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2016 recommendations of the international antiviral society–USA Panel. JAMA. 2016;316(2):191–210. doi:10.1001/jama.2016.8900.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Katlama C, Clotet B, Mills A, Trottier B, Molina JM, Grinsztejn B, et al. Efficacy and safety of etravirine at week 96 in treatment experienced HIV type-1 I nfected patients in the DUET-1 and DUET-2 trials. Antivir Ther. 2010;15(7):1045–52. doi:10.3851/IMP1662.

    Article  CAS  PubMed  Google Scholar 

  21. Product Information. Sovaldi, Gilead Sciences. 2016

  22. Product Information. Daclinza, Britol Meyers Squibb. 2016.

  23. AASLD-IDSA HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C. Located at http://www.hcvguidelines.org. Accessed August 30, 2016.

  24. Wyles DL, Ruane PJ, Sulkowski MS, et al. Daclatasvir plus sofosbuvir for HCV in patients coinfected with HIV-1. N Engl J Med. 2015;373(8):714–25.

    Article  CAS  PubMed  Google Scholar 

  25. Luetkemeyer AF, McDonald C, Ramgopal M, Noviello S, Bhore R, Ackerman P. 12 weeks of daclatasvir in combination with sofosbuvir for HIV-HCV coinfection (ALLY-2 study): efficacy and safety by HIV combination antiretroviral regimens. Clin Infect Dis. 2016;62(12):1489–96. doi:10.1093/cid/ciw163.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ghandhi Y, Adamczyk R, Wang Rea. Assessment of drug-drug interactions between daclatasvir and darunavir/ritonavir or lopinavir/ritonavir. 16th International Workshop on Clinical Pharmacology of HIV and Hepatitis Therapy.; May 26–28, 2015; Washington, DC. Abstract 80.

  27. Product Information. Viekera, AbbVie. 2016.

  28. Khatri A, Dutta S, Wang H, et al. Evaluation of drug-drug interactions between hepatitis C antiviral agents ombitasvir, paritaprevir/ritonavir, and dasabuvir and HIV-1 protease inhibitors. Clin Infect Dis. 2016;62(8):972–9. doi:10.1093/cid/civ1213.

    Article  PubMed  Google Scholar 

  29. Khatri A, Wang T, Wang H, et al. Drug-drug interactions of the direct acting antiviral regimen of ABT-450/r, ombitasvir, and dasabuvir with emtricitabine + tenofovir, raltegravir, rilpivirine, and efavirenz. [Abstract 483.]. 54th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC); September 5–9, 2014; Washington, DC.

  30. Sollima S, D’Avolio A, Cattaneo D, Micheli V, Milazzo L, Gervasoni C. Darunavir-based antiretroviral therapy may affect the efficacy og ombitasvir/paritaprevir/ritonavior and dasabuvir in HCV/HIV-1 coinfected patients. Clin Infect Dis. 2016. doi:10.1093/cid/ciw292.

    PubMed  Google Scholar 

  31. Khatri A, Trinh R, Zhao W, Podsadecki T, Menon R. Drug-drug interaction between the direct-acting antiviral regimen of ombitasvir/paritaprevir/rtionavir plus dasabuvir and the hiv antiretroviral agents dolutegravir or abacavir plus lamivudine. Antimicrob Agents Chemother. 2016. doi:10.1128/AAC.00795-16.

    PubMed Central  Google Scholar 

  32. Product Information. Zepatier, Merck. 2016.

  33. Caro L, Talaty JE, Guo Z, et al. Pharamcokinetic interactions between the HCV protease inhibiot MK-5172 and ritonavir boosted HIV protease inhibitors (ataznavair, lopinavir, dauranivir) in healthy volunteers [Abstract 487]. 64th Annual Meeting of the American Assocaition for the Study of Liver Diseases (AASLD), November 1–5, 2013, Washington, DC.

  34. Yeh W, Feng HP, Guo Z, et al. Drug-drug interactions between HCV inhibitors grazoprevir/elbasvir with dolutegravir [abstract 522]. Conference on Retroviruses and Opportunistics Infections (CROI), February 23–26, 2015, Seattle, WA.

  35. Osinusi A, Townsend K, Kohli A, Nelson A, Seamon C, Meissner EG, et al. Virlogic response following combined ledipasvir and sofosbuvir administration in patients with HCV genotype 1 and HIV co-infection. JAMA. 2015;313(12):1232–9. doi:10.1001/jama.2015.1373.

    Article  CAS  PubMed  Google Scholar 

  36. German P, Garrison K, Pang PS, et al. Drug-drug interactions between anti-HCV regimen ledipasvir/sofosbuvir and antiretrovirals. [Abstract 82.]. 22nd Conference on Retroviruses and Opportunistic Infections (CROI); February 23–26, 2015; Seattle, WA.

  37. Product Information. Descovy, Gilead Sciences. 2016.

  38. German P, Pang PS, West S, Han L, Sajwani K, Mathias A. Drug interactions between direct acting anti-HCV antivirals sofosbuvir and ledipasvir and HIV antiretrovirals. [Abstract 06.]. 15th International Workshop on Clinical Pharmacology of HIV and Hepatitis Therapy; May 19–21, 2014; Washington, DC.

  39. Garrison K, Custodio JM, pang PS, et al. Drug interactions between anti-HCV antivirals ledipasvir/sofosbuvir and integrase strand transfer inhibitor-based regimens. [Abstract 71.]. 16th International Workshop on Clinical Pharmacology of HIV & Hepatitis Therapy; May 26–28, 2015; Washington, DC.

  40. Product Information. Genvoya, Gilead Sciences. 2016.

  41. Product Information. Olysio, Janssen Therapeutics. 2016.

  42. Product Information. Epclusa, Gilead Sciences. 2016.

  43. Product Information. Harvoni, Gilead Sciences. 2016.

  44. • University of Liverpool Hep Drug Interaction Checker. Located at http://www.hep-druginteractions.org/. Accessed August 30, 2016. This is an important reference for a website that contains a comprehensive application for identifying drug interactions with primary care meds, HIV medications, and HCV direct acting antivirals

  45. • Northeast Caribbean AIDS Education and Training Center. Located at http://www.nynjaetc.org/. Accessed August 30, 2016. Key reference that contains printable charts that includes guidance for combining HCV and primary care medications with common DAA regimens used in managing HCV mono-infection and HCV/HIV co-infection.

Download references

Author information

Authors and Affiliations

  1. Division of HIV Medicine, Albany Medical College, Albany, NY, 12208, USA

    John J. Faragon PharmD, BCPS, AAHIV-P

  2. Northeast Caribbean AIDS Education and Training Center, 601 West 168th St #46, New York, NY, 10032, USA

    John J. Faragon PharmD, BCPS, AAHIV-P

Authors
  1. John J. Faragon PharmD, BCPS, AAHIV-P
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John J. Faragon PharmD, BCPS, AAHIV-P.

Ethics declarations

Conflict of Interest

Dr. John Faragon reports speaker fees from ABBVIE, BMS, GILEAD, JANSSEN, MERCK, and VIIV, as well as consultant fees for GILEAD outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Hepatitis C

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Faragon, J.J. Drug Interactions Associated with HIV and HCV Medications. Curr Treat Options Infect Dis 8, 404–415 (2016). https://doi.org/10.1007/s40506-016-0095-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40506-016-0095-3

Keywords

Search

Navigation