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Updated Guidelines for Managing HIV/HCV Co-Infection. John J Faragon , PharmD , BCPS, AAHIV-P Regional Pharmacy Director, NY/NJ AIDS Education and Training Center Pharmacist, HIV Medicine, Albany Medical Center. www.hcvguidelines.org Released 1/29/14!. Abbreviations. BOC – boceprevir
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Updated Guidelines for Managing HIV/HCV Co-Infection John J Faragon, PharmD, BCPS, AAHIV-P Regional Pharmacy Director, NY/NJ AIDS Education and Training Center Pharmacist, HIV Medicine, Albany Medical Center
Abbreviations • BOC – boceprevir • DAA – direct acting antiviral • IFN – interferon • PEG – pegylated interferon • RBV WB – ribavirin, weight based dosing • RGT – response guided therapy • SMV – simeprevir • SOF – sofosbuvir • TVR – telaprevir www.hcvguidelines.org
IFN Ineligible Definitions • Intolerance to IFN • Autoimmune hepatitis and other autoimmune disorders • Hypersensitivity to PEG or any of its components • Decompensated hepatic disease • History of depression, or clinical features consistent with depression • A baseline neutrophil count below 1500/μL, a baseline platelet count below 90,000/μL or baseline hemoglobin below 10 g/dL • A history of preexisting cardiac disease www.hcvguidelines.org
Standard Dosing • Sofosbuvir – 400mg once daily • Simeprevir – 150mg once daily • Peg Interferon – 180mcg once weekly • Ribavirin – weight based dosing • <75kg – 1000mg daily in divided doses • ≥75 kg – 1200mg daily in divided doses www.hcvguidelines.org
Drug Interactions Considerations • Sofosbuvir • Substrate for P-glycoprotein and breast cancer resistance protein • Intracellular metabolism mediated by hydrolase and nucleotide phosphorylation pathways • Minimal drug interactions expected • Simeprevir • Mild inhibitor of CYP1A2 activity and intestinal CYP3A4 • Does not affect hepatic CYP3A4 activity • Inhibits OATP1B1/3 and P-glycoprotein • Multiple drug interactions expected www.hcvguidelines.org
Sofosbuvir and HIV Medications (1 of 2) www.nynjaetc.org
Sofosbuvir and HIV Medications (2 of 2) www.nynjaetc.org
Simeprevir and HIV Medications (1 of 2) www.nynjaetc.org
Simeprevir and HIV Medications (2 of 2) www.nynjaetc.org
HIV/HCV Co-Infection, GT1 www.hcvguidelines.org
HIV/HCV Co-Infection, GT2 www.hcvguidelines.org
HIV/HCV Co-Infection, GT3 www.hcvguidelines.org
HIV/HCV Coinfection, GT4 www.hcvguidelines.org
HIV/HCV Coinfection, GT 5,6 www.hcvguidelines.org
HIV/HCV NOT Recommended www.hcvguidelines.org
Other Drug Interactions with Sofosbuvir www.nynjaetc.org
Other Drug Interactions with Simeprevir (1 of 2) www.nynjaetc.org
Other Drug Interactions with Simeprevir (2 of 2) www.nynjaetc.org
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