Hepatitis C Direct-Acting Antiviral Agents in HIV/HCV Co-infected Patients

At the time this article is being written, hepatitis C treatment is being revolutionized. The recent approval of sofosbuvir in the US for both mono- and co-infection is an astounding advance in the treatment for co-infection. In the label, there is no distinction between the treatment of co-infected and mono-infected patients. This has been shown to be true of all the direct-acting antiviral agents to date, but none so far have had it in their label. In our opinion, patients in the early stages of liver fibrosis can wait for the future combinations of agents to optimize their treatment responses and limit the risks of adverse events. For those who cannot wait, clinicians should follow the guidelines for mono-infected patients after the management of potential drug-drug interactions between the patient’s antiretroviral agents and hepatitis C direct-acting antiviral agents. A combination of pegylated-interferon and ribavirin with telaprevir, boceprevir, simeprevir, or sofosbuvir is adequate for genotype 1. For genotype 2, 12 weeks of sofosbuvir and ribavirin is recommended, and for genotype 3, 24 weeks of sofosbuvir and ribavirin are the label recommendations. For genotypes 4, 5, and 6, pegylated-interferon, ribavirin, and sofosbuvir is preferred. There is also an option for interferon-ineligible patients to use 24 weeks of sofosbuvir and ribavirin and to use up to 365 days of sosfosbuvir in patients with hepatocellular carcinoma awaiting liver transplant.