Which cART, Direct-Acting Antiviral Combos Pose the Least DDI Risk?

SAN FRANCISCO, CA—Drug-drug interactions (DDIs) are a distinct probability among patients with HIV and hepatitis C virus co-infection whose combination antiretroviral therapy (cART) includes direct-acting antivirals (DAAs), according to authors of a cohort study reported at The Liver Meeting® 2015.

“Significant potential DDIs are expected between cART and the currently available DAAs in the majority of HIV/HCV coinfected patients,” reported Isabelle Poizot-Martin, MD, Immuno-Hematology Clinic, APHM Hôpital Sainte-Marguerite in Marseille, France, and colleagues.

The authors analyzed data for 1,196 patients from the French HepaDat’AIDS cohort.

“All patients with detectable HCV-RNA, attending at least 1 visit in 2012 and not receiving HCV treatment at that time were enrolled,” Dr. Poizot-Martin reported. “Potential interactions between currently available DAAs (eg, boceprevir, daclatasvir, dasabuvir, ledipasvir, ombitasvir, ritonavir boosted paritaprevir, simeprevir, sofosbuvir, telaprevir) and the antiretroviral drugs received by the patients were assessed using the latest available data” in May 2015.

Of the patients, 703 were HCV treatment-naive and 493, HCV treatment failures.

The cART combinations prescribed included 2 nucleoside reverse transcriptase inhibitors (NRTIs) + 1 ritonavir-boosted protease inhibitor (bPI) (47.0% of treatment-naive and 38.8% of treatment-experienced patients); 2 NRTIs + 1 non-nucleoside reverse transcriptase inhibitor (NNRTI) (18.2% and 16.1%, respectively); 2 NRTIs + 1 integrase strand transfer inhibitor (18.8% and 17.7%, respectively), and other combinations (21.0% and 27.4%, respectively).

Combinations with limited potential for DDIs with DAAs were primarily 2 NRTIs + 1 integrase strand transfer inhibitor, the investigators noted.

The DAAs ledipasvir/sofosbuvir and daclatasvir/sofosbuvir, with and without ribavirin, “appeared the most suitable combinations in this population,” she noted.

“A close collaboration between hepatologists and HIV/AIDS specialists appears necessary for the management of HCV treatment concomitantly to cART,” Dr. Poizot-Martin concluded.