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Managing the HIV/HCV-Co-Infected Patient in the Direct-Acting Antiviral Era: a Review of Pertinent Drug Interactions

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

Opinion statement

Purpose of Review With the advent of direct acting antiviral (DAAs) drugs, hepatitis c is now a curabledisease. The human immunodeficiency virus (HIV) and hepatitis c virus (HCV) have similar risk factorsfor acquisition, and thus the co-infected patient population provides its own set of unique challenges. Theclinical course, monitoring and treatment of co-infected patients will be reviewed. Important druginteractions between DAAs and antiretroviral therapies (ART) will be highlighted.

Recent Findings HIV accelerates the natural history of HCV, and liver complications (including end-stageliver disease) resulting from HCV are the most common cause of death in co-infected persons. Five DAAregimens are been well studied in HIV/HCV co-infected patients with sustained virologic responsesbetween 91-100%. Two new DAA regimens have been approved by the FDA and can be used with ART.Some DAA regimens are limited by genotype, underlying renal disease, and decompensated cirrhosis.

Summary This review discusses the impact of HCV/HIV co-infection on morbidity and mortality inHIV-infected persons, focuses on the most current treatment options for HCV, reviews key druginteractions between ART and DAAs, and highlights future treatment options. We recommend thatall co-infected patients be treated for chronic HCV except those whose life expectancy is less than afew years and will not be remediated by HCV treatment.

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Authors and Affiliations

  1. Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, 20007, USA

    Rebecca N. Kumar MD

  2. Division of Infectious Diseases, MedStar Georgetown University Hospital, 3800 Reservoir Rd, NW 5PHC, Washington, DC, 20007, USA

    Gayle P. Balba MD

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  1. Rebecca N. Kumar MD
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Correspondence to Gayle P. Balba MD.

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Dr. Rebecca Kumar declares that she has no conflict of interest.

Dr. Gayle Balba reports serving as an investigator for Gilead and owning stock in Gilead and GlaxoSmithKline.

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

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This article is part of the Topical Collection on Hepatitis C

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Kumar, R.N., Balba, G.P. Managing the HIV/HCV-Co-Infected Patient in the Direct-Acting Antiviral Era: a Review of Pertinent Drug Interactions. Curr Treat Options Infect Dis 9, 411–424 (2017). https://doi.org/10.1007/s40506-017-0138-4

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