August 13, 2015
Up to three-quarters of HIV and hepatitis C (HCV)-coinfected individuals may need to switch antiretroviral therapy to avoid interactions with three common direct-acting antiviral (DAA) regimens, according to results of a chart review. More than one-third of patients taking a boosted protease inhibitor (PI) for HIV would not be able to reshape their antiretroviral regimen to avoid potential interactions with DAAs.
HIV/HCV-coinfected people achieve high sustained virologic response rates to interferon-free DAA regimens. But some DAAs may have problematic interactions with antiretrovirals metabolized by the same enzymes. To get a better understanding of how frequent such interactions may occur in an HIV clinic population, University of Pittsburgh researchers conducted this retrospective review of 127 patients coinfected with HIV and HCV.
Using three standard sources, the investigators considered reported interactions between antiretrovirals and (1) simeprevir (Olysio), (2) ledipasvir and (3) dasabuvir/ombitasvir/paritaprevir/ritonavir (Viekira Pak). Study participants made at least one clinic visit between January 2013 and August 2014. Researchers recommended ART switches for patients whose current ART they considered incompatible with a DAA being studied.
Among the 97 patients who needed an antiretroviral switch to start simeprevir, antiretroviral resistance history indicated that 47 (48%) could safely switch within the nonnucleoside class from efavirenz to rilpivirine (Edurant). Among 44 people taking a boosted PI, 40% could not make a safe switch that would allow use of simeprevir. Most of these people were taking a salvage regimen in which a PI was considered indispensable. Among patients who could not make a switch to accommodate simeprevir, 28% had evidence of advanced liver disease (APRI index > 1 and/or radiographic evidence of cirrhosis).
The University of Pittsburgh team believes their findings "highlight the complexity of treating HCV, even with the new DAAs, and are highly significant to real world HIV clinical practice settings." They suggest that clinicians balance "the level of urgency for HCV treatment ... with the severity of the [potential] DDI [drug-drug interaction]." That assessment, they propose, should include degree of liver fibrosis, extrahepatic comorbidities and indicated duration of HIV treatment.
Mark Mascolini is a freelance writer focused on HIV infection.
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