The recommendations in this table for concomitant use of select HIV drugs with U.S. Food and Drug Administration (FDA)–approved HCV direct-acting antiviral drugs are based on available pharmacokinetic interaction data or are predictions based on the known metabolic pathways of the agents. Whenever HIV and HCV drugs are used concomitantly, people 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 Liverpool HEP Drug Interaction Checker for updated information.
Note: Interactions with fosamprenavir, nelfinavir, and nevirapine are not included in this table because they are no longer commonly used and/or are not recommended by the Panel on Antiretroviral Guidelines for Adults and Adolescents. Please refer to the FDA product labels or the Liverpool HEP Drug Interaction Checker for information regarding drug interactions with these HIV protease inhibitors.
ARV Drugs | Individual Drug | Coformulated | ||||
|---|---|---|---|---|---|---|
| May be used in mild, moderate, or severe hepatic impairment (Child-Pugh class A, B, or C) | May be used in mild hepatic impairment (Child-Pugh class A) Should NOT be used in those with moderate to severe hepatic impairment (Cirrhosis classified as Child-Pugh class B or C) | |||||
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 | ✓ | ✓ Consider monitoring for hepatotoxicity.b If a PI/r is used with TDF, ↑ TDF concentrations are expected. Monitor for TDF-associated adverse events.a | 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 | |
| RPV PO and IM | ✓ | ✓ | ✓ | ✓ | ✓ | |
| DOR/ISL | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| BIC | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| 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. | ✓ Consider monitoring for hepatotoxicity.b If used with TDF, monitor for TDF-associated adverse events. | ✓ Consider monitoring for hepatotoxicity.c If used with TDF, monitor for TDF-associated adverse events. | x |
| EVG/c/TAF/FTC | ✓ | ✓ | ✓ | ✓ Consider monitoring for hepatotoxicity.b | ✓ Consider monitoring for hepatotoxicity.c | 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 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, people 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, people 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 ↑ = Increase 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; ISL = islatravir; LEN = lenacapavir; LPV/r = lopinavir/ritonavir; MVC = maraviroc; 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 | ||||||