The American Association for the Study of Liver Diseases (AASLD) says that people with hep C who are coinfected with HIV should be prioritized for HCV treatment. There are a number of highly effective treatments currently approved by the U.S. Food and Drug Administration (FDA) to treat hep C.
Full Answer
What are the treatment options for HIV-HCV coinfection?
For all persons with HIV-HCV coinfection, antiretroviral therapy should be initiated to treat HIV, regardless of the CD4 cell count and fibrosis stage.
When should HCV therapy be initiated in HIV infection?
For individuals living with HIV who have a CD4 count less than 200 cells/mm 3, it may be advisable to first initiate antiretroviral therapy and defer HCV therapy until the person is stable on antiretroviral therapy with suppressed HIV RNA levels.
Should HCV treatment be a priority for HIV-infected patients?
As such, HCV treatment in HIV-infected patients should be a priority for providers, payers, and patients.
When should art be initiated in patients with HCV/HIV coinfection?
Therefore, ART should be initiated in all patients with HCV/HIV coinfection, regardless of CD4 T lymphocyte cell count (AI). Initial ART regimens that are recommended for most patients with HCV/HIV coinfection are the same as those recommended for individuals without HCV infection.
Can you treat Hep C and HIV at the same time?
Direct-acting antiviral (DAA) medicines can cure most people with hepatitis C regardless of age, sex, race or HIV status. DAAs have few side effects and you can take them without interrupting your HIV treatment.
When should HIV treatment be started?
People with HIV should start taking HIV medicines as soon as possible after HIV is diagnosed. A main goal of HIV treatment is to reduce a person's viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test.
Does HCV delay HIV seroconversion?
Similarly, HCV could have delayed HIV seroconversion and the failure of PEP as a result of supposed pathogenic interactions between the two viruses. In the case of sexual or professional exposure to both viruses a prolonged follow-up is recommended to cover the risk of late seroconversion.
Is HCV more infectious than HIV?
The hepatitis C virus is a single stranded RNA virus and is approximately 10 times more infectious than HIV through blood-to-blood contact.
Does PEP stop seroconversion?
PEP initiated soon after exposure can reduce the risk of HIV seroconversion after occupational and non-occupational exposures, provided adherence to medications is sufficient (1–4).
When is a HCV test conclusive?
Even at 15 weeks, only about 80% of HCV-infected persons will have positive HCV Ab [MMWR rr5005a1]. Therefore, the6-month (24-week) HCV antibody test is considered to be conclusive in excluding HCV acquisition: ≥97% will be positive at 6 months post exposure [MMWR rr5005a1].
What is a seroconversion rate?
Seroconversion is the transition from the point of viral infection to when antibodies of the virus become present in the blood. Given that many diagnostic tests use the presence of antibodies to infer illness, understanding seroconversion becomes a very important part of immunology and virology.
How long can you live without Hep C treatment?
Like the human papillomavirus (HPV), early acute hepatitis C can clear on its own without treatment; this happens about 25% of the time. However, it's more likely that the virus will remain in your body longer than six months, at which point it's considered to be chronic hepatitis C infection.
Treatment
- This section provides guidance on the treatment of chronic HCV infection in HIV/HCV-coinfected patients. For individuals with acute HCV infection, please refer to the Acute HCV section. HIV/HCV-coinfected patients suffer from more liver-related morbidity and mortality, nonhepatic …
Clinical significance
- Due to shared modes of transmission, HIV/HCV-coinfected patients are also at risk for hepatitis B virus (HBV) infection. Reactivation of HBV has been reported in patients starting DAA HCV therapy who are not on active HBV agents. Consistent with general recommendations for the assessment of both HIV- and HCV-infected patients, all patients initiating HCV DAA therapy should be assess…
Prevention
- Extensive recommendations for antiretroviral therapy use, including for persons anticipating HCV treatment, are available at jama.jamanetwork.com and aidsinfo.nih.gov.
Medical uses
- Antiretroviral drug switches may be performed to allow compatibility with DAAs with the goal of maintaining HIV suppression without compromising future options. Considerations include prior treatment history, responses to antiretroviral therapy, resistance profiles, and drug tolerance (Gunthard, 2014); (DHHS, 2017). Treatment interruption in HIV/HCV-coinfected individuals is no…
Results
- Although fewer HIV/HCV-coinfected patients than HCV-monoinfected patients have been treated in DAA trials, efficacy rates to date have been remarkably similar between the groups (Sulkowski, 2013); (Sulkowski, 2014); (Dieterich, 2014b); (Rodriguez-Torres, 2015); (Osinusi, 2015); (Sulkowski, 2015); (Dieterich, 2015); (Naggie, 2015); (Wyles, 2015). Thus, results from HCV monoinfection st…
Interactions
- Daclatasvir is metabolized by cytochrome P450 (CYP) 3A4 and is therefore susceptible to drug interactions with potent inducers and inhibitors of this enzyme (Eley, 2014). The dose of daclatasvir should be increased from 60 mg to 90 mg when used with efavirenz, etravirine, or nevirapine (Bifano, 2013). The dose of daclatasvir should be decreased from 60 mg to 30 mg wh…
Adverse effects
- The safety, tolerability, and efficacy of the second-generation NS3/4A serine protease inhibitor grazoprevir (MK-5172) plus the NS5A inhibitor elbasvir (MK-8742) were assessed in patients with HIV/HCV coinfection in the C-EDGE COINFECTION study. C-EDGE COINFECTION was a phase 3, nonrandomized, open-label, single-arm study in which treatment-naive patients with genotype 1, …
Side effects
- The safety and efficacy of 12 weeks of ledipasvir/sofosbuvir were evaluated in the phase 2, single-center, open-label ERADICATE trial, which included 50 HIV/HCV-coinfected patients with genotype 1 infection who were treatment naive without cirrhosis (Osinusi, 2015). Thirteen patients were not receiving antiretroviral therapy and 37 patients were on protocol-allowed medications (tenofovir…
Chemistry
- Ledipasvir absorption is pH dependent. Refer to product labeling for guidance on temporal separation and dosing of gastric acid modifying agents.
Administration
- In patients with an eGFR <60 mL/min who are taking tenofovir disoproxil fumarate with ledipasvir/sofosbuvir, renal parameters should be checked at baseline and at the end of treatment. Baseline parameters should include measuring creatinine level, electrolytes (including phosphorus), and urinary protein and glucose, according to recent guidelines for the manageme…
Research
- The combination of simeprevir plus sofosbuvir, with or without ribavirin, has been studied in the phase 2 COSMOS trial in patients with HCV monoinfection (Lawitz, 2014b). This study is the main basis for the recommendation supporting use of this combination for genotype 1a or 1b monoinfection. Simeprevir plus sofosbuvir has been used anecdotally in patients with HIV/HCV …
Pharmacology
- Velpatasvir is available only in a fixed-dose combination tablet with sofosbuvir. Velpatasvir is metabolized by CYP3A4, CYP2C8, and CYP2B6. It does not appear to inhibit or induce any CYP enzymes. Velpatasvir is a substrate for P-gp and BCRP, and inhibits P-gp, BCRP, and OATP1B1/1B3 but does not induce any transporters.