High frequency of potential interactions between direct‐acting antivirals and concomitant therapy in HIV/hepatitis C virus‐coinfected patients in clinical practice

• Published in: HIV medicine Vol. 18; no. 7; pp. 445 - 451
• Main Authors: Macías, J, Monge, P, Mancebo, M, Merchante, N, Neukam, K, Real, LM, Pineda, JA
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-08-2017
• Subjects: Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiviral agents; Antiviral Agents - therapeutic use; Coinfection - drug therapy; common medications; Cross-Sectional Studies; daclatasvir; direct acting antiviral agents against HCV; Dosage; Drug abuse; Drug Interactions; Drugs; drug‐drug interactions; Female; Genotype & phenotype; Hepatitis; Hepatitis C; Hepatitis C, Chronic - complications; Hepatitis C, Chronic - drug therapy; HIV; HIV Infections - complications; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Infections; ledipasvir; Male; Middle Aged; paritaprevir/r/ombitasvir ± ombitasvir; Patients; Prospective Studies; simeprevir; sofosbuvir; Spain; Tertiary Care Centers; Therapy; Viruses; direct acting antiviral agents against HCV; ledipasvir; sofosbuvir; drug-drug interactions; simeprevir; antiretroviral therapy; common medications; daclatasvir; paritaprevir/r/ombitasvir ± ombitasvir
• ISSN: 1464-2662; 1468-1293
• DOI: 10.1111/hiv.12471

Objectives
The aim of the study was to analyse the frequency and degree of potential drug−drug interactions (DDIs) between direct‐acting antivirals (DAAs) and concomitant medication used by HIV/hepatitis C virus (HCV)‐coinfected patients, including antiretroviral therapy (ART) and other drugs.
Methods
All patients with HIV infection and viraemic HCV genotype 1, 3 or 4 coinfection attending a tertiary care centre in Spain (November 2014 to November 2015) were included in the study. DDIs were classified as major, i.e. drugs should not be co‐administered, or minor, i.e. close monitoring, dosage alteration or change in timing may be required if drugs are co‐administered, following the http://www.hep-druginteractions.org database recommendations.
Results
A total of 244 patients were included in the study, of whom 224 (92%) were previous injecting drug users. Major DDIs were found for: paritaprevir‐r/ombitasvir plus dasabuvir (3D), in 60 (44%) of 138 individuals with genotype 1; paritaprevir‐r/ombitasvir (2D), in 22 (37%) of 60 individuals with genotype 4; sofosbuvir/ledipasvir (SOF/LDV), in four (2%) of 198 patients with genotype 1 or 4; simeprevir (SMV) plus SOF, in 160 (81%) of 198 patients with genotype 1 or 4; daclatasvir (DCV) plus SOF, in seven (3%) of 244 patients with genotype 1, 3 or 4 (P < 0.001). Minor DDIs were found for: 3D, in 123 (89%) individuals with genotype 1; 2D, in 52 (87%) individuals with genotype 4; SOF/LDV, in 154 (78%) patients with genotype 1 or 4; SMV plus SOF, in 129 (65%) patients with genotype 1 or 4; DCV plus SOF, in 149 (61%) patients with genotype 1, 3 or 4 (P < 0.001).
Conclusions
Drug−drug interactions between DAAs and ART or other commonly prescribed medications are frequently found among HIV/HCV‐coinfected patients. Potential major and minor DDIs are more frequent with 3D, 2D and SMV plus SOF regimens.