Managing Drug Interactions

By: Marcus J. Hopkins, Blogger

For a while, now, HEAL Blog entries have focused on either the HIV-related, or the HCV-related treatment experience. While both perspectives play vital roles in the discussion of treatment options, focusing solely on one to the exclusion of the other leaves out a complicated truth: not every HCV treatment option is going to interact well with existing HIV regimens.

In writing this, I’m going to do my best to make certain that the data is presented in a way that is, if not “easy” to understand, at least doesn’t make any non-medical professionals want to beat me up, should they encounter me in a dark alley. Any time there’s a discussion involving medications, it’s very difficult to walk the line between detailed analysis and “palatability” – can anyone, regardless of their level of education, understand what is being said.

This becomes more difficult because recommendations are made using the chemical compound names, rather than the brand names (i.e. – “paritaprevir, ritonavir, ombitasvir, plus dasabuvir” vs. Viekira Pak). Using the chemical compounds reduces confusions when these discussions are had in other parts of the world, where drugs may have different brand names or have licensed generic options (unlike the U.S.). While that’s fantastic for medical professionals, it often leaves laypeople looking at a report as if it’s written in Latin…and, sometimes, parts of it may be.

Additionally, any discussions of medication will naturally involve oftentimes complicated processes for how those medications are (or are not) metabolized and/or absorbed into the body. These processes can also lead to great confusion amongst laypeople, largely because the average person isn’t familiar with the various enzymes, proteins, inhibitors, or types of drugs and how they involve the body. Further to that point, explaining these complex processes in ways that are easy to understand can leave out some nuance in the discussion, which may leave patients feeling like they’re not “getting the whole truth.” I have found this to be the case, particularly within populations and regions where mistrust of the government and medical professionals runs high (e.g. – Appalachia).

Essentially, the biggest concern for patients co-infected with HIV and HCV is one of drug interactions. In 2016, there are myriad treatment options for HIV, but only seven new HCV regimens that easily tolerated on their own; this means that each of those seven new options has to be paired in trials with various types of HIV regimens to so how they react with the general population to determine whether or not the drugs will be more or less effective.

Photo of a pill box with the words, "Caution"

Photo Source: Doctor Tipster

What that breaks down to is that, when treating HCV in HIV-infection populations, in order for the HCV treatment to be effective, the HIV regimen may need to be changed. Rather than go through the numerous pros and cons, it’s easier for use to give a list of combinations not suggested:

  • Antiretroviral treatment (ART) interruption to allow HCV therapy is NOT recommended (i.e. – don’t stop treating HIV in lieu of treating HCV)
  • Harvoni (Gilead) should NOT be used with cobicistat when given with Viread (Gilead)
  • Sovaldi (Gilead) and Harvoni should NOT be used with Aptivus (Boehringer-Ingelheim)
  • Viekira Pak (AbbVie) should NOT be used with Prezista (Janssen), Sustiva (Bristol-Myers Squibb), Kaletra (AbbVie), or Edurant (Janssen)
  • Viekira Pak should NOT be used in HIV/HCV co-infection patients who are not currently taking ART
  • Ribaviren (to treat HCV) should NOT be used with Videx (BMS), Zerit (BMS), or Retrovir (GlaxoSmithKlein)
  • Olysio should NOT be used with cobicistat, Sustiva, Intelence (Janssen), Viramune (Boehringer-Ingelheim), or any HIV protease inhibitor (e.g. – Kaletra, Norvir, or Reyataz)

Aside from that list of “DO NOTs,” most of the newer, single-pill HIV regimens are relatively safe to use with the newer HCV regiments, provided that there are various dosing options for the latter. Ultimately, one should never substitute the word of a blog writer (or any other writer) over the recommendations of a trained physician. This list, however, should allow patients to get a better idea of what’s out there, and how to start seeking treatment.
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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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