The recommendations in this table for concomitant use of select HIV drugs with U.S. Food and Drug Administration (FDA)–approved HCV DAA drugs are based on available pharmacokinetic (PK) interaction data or are predictions based on the known metabolic pathways of the agents. (Instances where PK interaction data are limited or not available are indicated in the table.) Whenever HIV and HCV drugs are used concomitantly, patients should be closely monitored for HIV and HCV virologic efficacy and potential toxicities. Because the field of HCV therapy is rapidly evolving, readers also should refer to the latest drug product labels and the HCV Guidance for updated information.
Note: Interactions with fosamprenavir (FPV) and nelfinavir (NFV) are not included in this table. Please refer to the FDA product labels for information regarding drug interactions with these HIV protease inhibitors (PIs).
ARV Drugs | Individual Drug | Coformulated | ||||
|---|---|---|---|---|---|---|
SHOULD NOT BE USED IN THOSE WITH MODERATE TO SEVERE HEPATIC IMPAIRMENT | ||||||
Sofosbuvir | Ledipasvir/ | Sofosbuvir/ | Sofosbuvir/ | Glecaprevir/ | Elbasvir/ | |
| 3TC | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| ABC | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| FTC | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| TAF | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| TDF | ✓ | ✓ Monitor for TDF-associated adverse events. | ✓ Monitor for TDF-associated adverse events. | ✓ Monitor for TDF-associated adverse events. | ✓ | ✓ |
| Unboosted ATV | ✓ | ✓ | ✓ | x | x | x |
| ATV/r or ATV/c | ✓ | ✓ If a PI/r or PI/c is used with TDF, ↑ TDF concentrations are expected. If coadministration is necessary, monitor for TDF-associated adverse events.a | ✓ If a PI/r or PI/c is used with TDF, ↑ TDF concentrations are expected. If coadministration is necessary, monitor for TDF-associated adverse events.a | x | x | x |
| DRV/r or DRV/c | ✓ | ✓ If a PI/r is used with TDF, ↑ TDF concentrations are expected. Monitor for TDF-associated adverse events.a Consider monitoring for hepatotoxicity.b | x | x | ||
| LPV/r | ✓ | x | x | x | ||
| TPV/r | x | x | x | x | x | x |
| DOR | ✓ | ✓ If used with TDF, monitor for TDF-associated adverse events. | ✓ | ✓ | ✓ | ✓ |
| EFV | ✓ | x | x | x | x | |
| ETR | ✓ | x | x | x | x | |
| NVP | ✓ | x | x | x | x | |
| RPV PO and IM | ✓ | ✓ | ✓ | ✓ | ✓ | |
| BIC/TAF/FTC | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| CAB PO and IM | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| DTG | ✓ | ✓ If used with TDF, monitor for TDF-associated adverse events. | ✓ | ✓ | ✓ | ✓ |
| EVG/c/TDF/FTC | ✓ | x | ✓ If used with TDF, monitor for TDF-associated adverse events. | ✓ If used with TDF, monitor for TDF-associated adverse events. Consider monitoring for hepatotoxicity.b | ✓ If used with TDF, monitor for TDF-associated adverse events. Consider monitoring for hepatotoxicity.c | x |
| EVG/c/TAF/FTC | ✓ | ✓ | ✓ | ✓ Consider monitoring for hepatotoxicity.e | ✓ Consider monitoring for hepatotoxicity.f | x |
| RAL | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| MVC | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| FTR | ✓ | ✓ | ✓ | x Use alternative HCV regimen if possible. | ✓ | x Use alternative HCV regimen if possible. |
| LEN | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| a Consider using an alternative HCV treatment or ARV regimen to avoid increases in TDF exposure. If coadministration is necessary, monitor patient for TDF-associated adverse events. b Voxilaprevir exposures can increase when it is coadministered with pharmacologically boosted DRV or EVG. Until more safety data in clinical settings become available, patients who are receiving voxilaprevir and pharmacologically boosted DRV or EVG should be monitored for hepatotoxicity. c Glecaprevir exposures can increase when it is coadministered with EVG/c. Until more safety data in clinical settings become available, patients who are receiving glecaprevir and EVG/c should be monitored for hepatotoxicity. Key to Symbols: ✓ = ARV agents that can be used concomitantly x = ARV agents not recommended ? = Data on PK interactions with ARV drug are limited or not available ↑ = Increase ↓ = Decrease Key: 3TC = lamivudine; ABC = abacavir; ARV = antiretroviral; ATV = atazanavir; ATV/c = atazanavir/cobicistat; ATV/r = atazanavir/ritonavir; BIC = bictegravir; CAB = cabotegravir; DAA = direct-acting antiviral; DOR = doravirine; DRV = darunavir; DRV/c = darunavir/cobicistat; DRV/r = darunavir/ritonavir; DTG = dolutegravir; EFV = efavirenz; ETR = etravirine; EVG = elvitegravir; EVG/c = elvitegravir/cobicistat; FTC = emtricitabine; FTR = fostemsavir; HCV = hepatitis C virus; IM = intramuscular; LEN = lenacapavir; LPV/r = lopinavir/ritonavir; MVC = maraviroc; NVP = nevirapine; PI = protease inhibitor; PI/c = protease inhibitor/cobicistat; PI/r = protease inhibitor/ritonavir; PK = pharmacokinetic; PO = oral; RAL = raltegravir; RPV = rilpivirine; TAF = tenofovir alafenamide; TDF = tenofovir disoproxil fumarate; TPV/r = tipranavir/ritonavir | ||||||