By: Marcus J. Hopkins, Blogger
The Department of Health and Human Services released updated Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV in October 2017, which included updates for best practices, treatment protocols and recommendations, which drugs not to use, treatment for virologic failure, regimen switching, adherence to the continuum of care, drug interactions, and Hepatitis B (HBV) and Hepatitis C (HCV) co-infection treatment guidelines.
Because emtricitabine (FTC – Truvada, Descovy, Stribild, Genvoya, Odefsey), lamivudine (3TC – Epivir, Epivir-HBV, Combivir, Kivexa, Trizivir), tenofovir disoproxil fumarate (TDF- Viread, Atripla, Complera, Stribild, Truvada), and tenofovir alafenamide (TAF – Genvoya, Odefsey, Descovy) have activity against both HIV and HBV, an Antiretroviral Therapy (ART) should include (TAF or TDF) plus (3TC of FTC) to fully suppress the viruses. Other HBV treatment regimens, including adefovir (Hepsera) alone or in combination with 3TC or FTC, are not recommended for patients co-infected with HIV/HBV.
HBV reactivation has been observed in persons with HBV infection during interferon-free HCV treatment. For that reason, all patients initiating HCV therapy should be tested for HBV. Persons with HCV/HIV coinfection and active HBV infection should receive two agents with anti-HBV activity prior to initiating HCV therapy.
For HCV, ART may slow the progression of liver disease related to HCV by preserving or restoring immune function and reducing HIV-related immune activation and inflammation. For most persons with HCV/HIV coinfection, including those with cirrhosis, the benefits of ART outweigh concerns regarding drug-induced liver injury. Therefore, ART should be initiated in all patients with HCV/HIV coinfection, regardless of CD4 T-cell count. All patients with HCV/HIV coinfection should be evaluated for HCV therapy and have their liver fibrosis stage assessed to inform the length of their therapy, ribavirin need (a concern with some regimens), and subsequent risk of hepatocellular carcinoma and liver disease complications
The document also includes an extensive list of the various drug interactions between HIV and HCV drugs, including the three newest HCV regimens, Epclusa, Vosevi, and Mavyret. HEAL Blog previously covered HCV and HIV drug interactions (Hopkins, 2016). While the document is clearly meant for medical and other healthcare professionals, if you would like more information, please check out the link below in the citation.
- AIDSinfo. (2017, October 17). Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. Rockville, MD: Department of Health and Human Services: AIDSinfo: Guidelines. Retrieved from: https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf
- Hopkins, M. (2016, February 22). Managing Drug Interactions. Washington, DC: Community Access National Network: HEAL Blog. Retrieved from: https://communityaccessnationalnetwork.wordpress.com/2016/02/22/managing-interactions/
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.