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

ARV Drugs	Individual Drug	Coformulated
	Individual Drug			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/ Velpatasvir	Sofosbuvir/ Velpatasvir/ Voxilaprevir	Glecaprevir/ Pibrentasvir	Elbasvir/ Grazoprevir
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

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