HIV and HCV Therapies in 2016: Optimal Regimens

Approximately 30% of HIV individuals are coinfected with HCV. It is known that HIV accelerates liver fibrosis progression, even with the use of combination antiretroviral therapy, and HCV is now a leading cause of morbidity and mortality in this patient population. Past HCV therapy with pegylated interferon and ribavirin in this setting has demonstrated poor outcomes, which were inferior to those seen in HCV-monoinfected populations, especially in patients with genotype 1 infections. This and the high rate of adverse events with these agents resulted in very limited uptake of these treatment options. The recent advent of direct-acting antiviral therapy for HCV has resulted in vastly improved outcomes in HCV-infected patients. These agents have also demonstrated markedly improved outcomes in HIV/HCV-coinfected settings, with sustained virological response rates now being equivalent to non-HIV patients. The recent introduction of all-oral, interferon-free, and in some instances-ribavirin free, therapies has further improved sustained viral response rates that exceed 95% with minimal adverse events. HIV/HCV-coinfected patients, however, have particular issues with drug-drug interactions with antiretroviral therapy regimens, which need to be carefully evaluated and occasionally require modification.