Managing Drug Interactions in HIV/HCV-Coinfected Patients

AUGUST 23, 2016
HIV and hepatitis C virus (HCV) are both serious health concerns, affecting more than 5 million individuals in the United States combined.
Both viruses can result in significant health consequences, especially when left untreated. HIV attacks the body’s immune system, specifically the CD4 cells, which fight off infection. Meanwhile, chronic HCV can lead to serious liver problems, including cirrhosis or liver cancer.
Because of similar transmission routes, HIV/HCV coinfection isn’t uncommon. In fact, about 25% of HIV-infected patients in the United States are coinfected with HCV. Additionally, about 80% of those with HIV who inject drugs also have HCV.
This is a major concern because HIV/HCV-coinfected patients experience more liver-related morbidity and mortality, nonhepatic organ dysfunction, and overall mortality than HCV-monoinfected patients.

Historically, HCV therapy uptake has been lower in the coinfected population due to lower response rates, comorbidities, patient and practitioner perceptions, and poor tolerability to interferon-based therapy. In recent years, however, HCV direct-acting antivirals (DAAs) have scaled some of these barriers.
Recent data suggests HCV/HIV-coinfected patients treated with newer DAA regimens have efficacy rates comparable to those of HCV-monoinfected patients in as little as 12 weeks. However, complex drug interactions between DAAs and antiretroviral therapy (ART) require close awareness and treatment adjustments.
Pharmacists may perform ART switches in collaboration with the HIV practitioner to allow compatibility of DAAs. Alternatively, HCV regimens should be chosen in such a manner that minimizes interactions with ART. Treatment interruption in HIV/HCV-coinfected individuals isn’t recommended.
Here are the major drug interactions for each DAA, with a helpful Table at the end:

Timothy O'Shea, PharmD
Timothy O'Shea, PharmD
Timothy O'Shea, PharmD, is a Clinical Pharmacist working at a large health insurance plan on the east coast. Additionally he works per diem at a retail pharmacy chain. He graduated from MCPHS University - Boston in 2015 and subsequently completed a PGY-1 Managed Care Pharmacy Residency. His professional interests include pharmacy legislation and managed care pharmacy. He can be followed on Twitter at @toshea125.