Table 18. Concomitant Use of Selected Antiretroviral Drugs and Hepatitis C Virus Direct-Acting Antiviral Drugs for Treatment of Hepatitis C Virus in Adults with HIV

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Table 18. Concomitant Use of Selected Antiretroviral Drugs and Hepatitis C Virus Direct-Acting Antiviral Drugs for Treatment of Hepatitis C Virus in Adults with HIV
Selected HIV Drugs HCV Direct-Acting Antiviral Agents
NS5A Inhibitor NS5B Inhibitor Coformulated
  SHOULD NOT BE USED IN THOSE WITH MODERATE TO SEVERE HEPATIC IMPAIRMENT
(Cirrhosis classified as Child-Pugh class B or C)
NS5A/NS5B Inhibitor NS5A/NS5B Inhibitor NS5A/NS5B Inhibitor/NS3/4A PI NS5A Inhibitor/NS3/4A PI NS5A Inhibitor/NS3A/4A PI NS5A Inhibitor/NS3A/4A PI plus NS5B Inhibitor
Daclatasvir Sofosbuvir Ledipasvir/ Sofosbuvir Sofosbuvir/ Velpatasvir Sofosbuvir/ Velpatasvir/ Voxilaprevir Glecaprevir/ Pibrentasvir Elbasvir/ Grazoprevir Ombitasvir/ Paritaprevir/ RTV plus Dasabuvira
NRTIs
3TC
ABC
FTC
TDF
Monitor for TDF-associated adverse events.

Monitor for TDF-associated adverse events.

Monitor for TDF-associated adverse events.
TAF
PIs
Unboosted ATV X X X b
ATV/r or ATV/c
↓ daclatasvir dose to 30 mg/day

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.d

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.d
X X X c
DRV/r or DRV/c
If a PI/r is used with TDF, ↑ TDF concentrations are expected. Monitor for TDF-associated adverse events.d Consider monitoring for hepatotoxicity.e
X X X
LPV/r X X X X
TPV/r ? X X X X X X X
NNRTIs
DOR  

If used with TDF, monitor for TDF-associated adverse events.
EFV
↑ daclatasvir dose to 90 mg/day
X X X X X
ETR
↑ daclatasvir dose to 90 mg/day
X X X X X
NVP
↑ daclatasvir dose to 90 mg/day
X X f X X
RPV X
INSTIs
BIC/TAF/FTC
DTG
If used with TDF, monitor for TDF-associated adverse events.
EVG/c/ TDF/ FTC
↓ daclatasvir dose to 30 mg/day
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.e

If used with TDF, monitor for TDF-associated adverse events. Consider monitoring for hepatotoxicity.g
X X
EVG/c/ TAF/ FTC
↓ daclatasvir dose to 30 mg/day

Consider monitoring for hepatotoxicity.e

Consider monitoring for hepatotoxicity.g
X X
RAL
CCR5 Antagonist
MVC X
a Dasabuvir must be prescribed with ombitasvir/paritaprevir/RTV.
b Reduce ATV dose to 300 mg and instruct the patient to take it in the morning at the same time as ombitasvir/paritaprevir/RTV plus dasabuvir. If RTV cannot be used, choose an alternative HCV regimen.
c This HCV regimen contains RTV. If ATV is part of the ARV regimen, prescribe ATV 300 mg without COBI or RTV. The modified ARV regimen should be taken in the morning at the same time as ombitasvir/paritaprevir/RTV plus dasabuvir. Resume RTV or COBI regimen when HCV therapy is completed.
d 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.
e Voxilaprevir exposures can increase when it is coadministered with pharmacologically boosted DRV or EVG. Until more safety data in clinical settings becomes available, patients who are receiving voxilaprevir and pharmacologically boosted DRV or EVG should be monitored for hepatotoxicity.
f Consider alternative ARV or HCV regimen. If used together, monitor for HCV efficacy.
g Glecaprevir exposures can increase when it is coadministered with EVG/c. Until more safety data in clinical settings becomes 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; COBI = cobicistat; DAA = direct-acting antiviral agents; DOR = doravirine; DRV = darunavir; DRV/c = darunavir/cobicistat; DRV/r = darunavir/ritonavir; DTG = dolutegravir; DSV = dasabuvir; EFV = efavirenz; ETR = etravirine; EVG = elvitegravir; EVG/c = elvitegravir/cobicistat; FDA = Food and Drug Administration; FPV = fosamprenavir; FTC = emtricitabine; HCV = hepatitis C virus; IDV = indinavir; INSTI = integrase strand transfer inhibitor; LPV/r = lopinavir/ritonavir; MVC = maraviroc; NFV = nelfinavir; NNRTI = non-nucleoside reverse transcriptase inhibitor; NRTI = nucleoside reverse transcriptase inhibitor; NVP = nevirapine; PI = protease inhibitor; PI/c = protease inhibitor/cobicistat; PI/r = protease inhibitor/ritonavir; PK = pharmacokinetic; RAL = raltegravir; RPV = rilpivirine; RTV = ritonavir; SQV = saquinavir; TAF = tenofovir alafenamide; TDF = tenofovir disoproxil fumarate; TPV/r = tipranavir/ritonavir