Version June 2024
| Glecaprevir-pibrentasvir | Sofosbuvir-velpatasvir | Sofosbuvir-velpatasvir-voxilaprevir | Sofosbuvir | Daclatasvir* | Ledipasvir-sofosbuvir | Elbasvir-grazoprevir | |
| Bictegravir | ✓¶ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Dolutegravir | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Cabotegravir (oral) | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Elvitegravir (cobicistat boosted) | ✓◊ | Caution when used with TDFΔ | Caution when used with TDFΔ§ | ✓ | Caution: decrease daclatasvir to 30 mg daily | Caution when used with TDFΔ | Not recommended |
| Raltegravir | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Rilpivirine (oral) | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Efavirenz | Not recommended | Not recommended | Not recommended | ✓ | Caution: increase daclatasvir to 90 mg daily | ✓ | Not recommended |
| Doravirine | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Cabotegravir-rilpivirine (long- acting injectable) | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Darunavir (boosted) | Not recommended | Caution when used with TDFΔ | Caution when used with TDFΔ§ | ✓ | ✓ | Caution when used with TDFΔ | Not recommended |
| Atazanavir (boosted) | Not recommended | Caution when used with TDFΔ | Not recommended | ✓ | Caution: decrease daclatasvir to 30 mg daily | Caution when used with TDFΔ | Not recommended |
| Other agents that are contraindicated or not recommended | Etravirine Tipranavir | Etravirine Nevirapine Tipranavir | Etravirine§ Nevirapine§ Lopinavir-ritonavir Tipranavir§ Fostemsavir¥ | Tipranavir | Tipranavir | Etravirine Nevirapine Lopinavir-ritonavir Tipranavir Fostemsavir¥ | |
| Other potential concerns or caution | Kidney function monitoring when used with TDF regimensΔ | Kidney function monitoring when used with TDF regimensΔ§ | Caution with etravirine: increase daclatasvir to 90 mg daily Caution with tipranavir (ritonavir boosted): decrease daclatasvir to 30 mg daily | Kidney function monitoring when used with TDF regimensΔ |
The checkmark indicates that the HCV antiviral and the antiretroviral agent can be coadministered safely. Abacavir-lamivudine and TAF-emtricitabine can be used with all acceptable combinations above. Caution with TDF-containing regimens is indicated in the table. Some of these combinations have not been studied directly, but their safety or potential interactions are extrapolated from known pharmacokinetics.
This is not a complete description of interactions between HCV antivirals and antiretroviral agents. When initiating or altering drug therapy, use of a drug interactions database, such as Lexicomp drug interactions, is advised.TAF: tenofovir alafenamide; TDF: tenofovir disoproxil fumarate; DAA: direct-acting antiviral.
* Not available in the United States or Canada but available in other countries.
¶ The European product label for bictegravir-emtricitabine-tenofovir alafenamide notes caution when used with glecaprevir-pibrentasvir, because levels of bictegravir may be elevated with coadministration.
Δ Coadministration of ledipasvir, velpatasvir, or voxilaprevir with TDF results in elevated levels of tenofovir, particularly when ritonavir-boosted protease inhibitors or cobicistat-containing regimens are also used. In contrast, coadministration of TAF with ledipasvir, velpatasvir, or voxilaprevir does not result in elevated levels of tenofovir. If ledipasvir or velpatasvir is to be used in a patient taking a TDF-containing regimen, we switch the TDF to TAF, if possible. If that switch is not possible and no other HCV regimen can be used, we check a baseline creatinine, urinalysis, and phosphate level and monitor for tenofovir-associated renal toxicity (eg, with creatinine and phosphate at least monthly) while on HCV therapy.
◊ Glecaprevir and pibrentasvir levels are elevated in this setting. Although the elevations do not appear to be clinically relevant, monitoring for hepatic toxicity (eg, checking transaminases every 4 weeks) is suggested.
§ Contraindication or caution is warranted with these drugs because of the potential interactions with sofosbuvir and/or velpatasvir, with which voxilaprevir is coformulated.
¥ The active metabolite of fostemsavir (temsavir) may increase plasma concentrations of grazoprevir and voxilaprevir through inhibition of OATP1B1/3. Other DAA regimens are recommended for individuals taking fostemsavir.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
