Use of first-generation hcv protease inhibitors in patients coinfected by hiv and hcv genotype 1

Liver International

Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.)

Original Article

Dominique Salmon^1,*, Cedric Arvieux², Marc Bourlière³, Patrice Cacoub⁴, Phillipe Halfon⁵, Karin Lacombe⁶, Georges Pageaux⁷, Gilles Pialoux⁸, Lionel Piroth⁹, Isabelle Poizot-Martin¹⁰, Eric Rosenthal¹¹, Stanislas Pol¹²

DOI: 10.1111/liv.12363

This article is protected by copyright. All rights reserved.

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/liv.12363

Publication History
Accepted manuscript online: 18 OCT 2013 11:55AM EST
Manuscript Accepted: 13 OCT 2013
Manuscript Revised: 1 OCT 2013
Manuscript Received: 5 APR 2013

Abstract

Background

In HCV genotype 1-infected patients with HIV co-infection, tritherapy [HCV protease inhibitors (PIs) plus peg-interferon and ribavirin] has been shown to have an increased rate of sustained virological response. However, complex drug-to-drug interactions and tolerability issues remain a concern.

Methods

Under the auspices of four French scientific societies of medicine, a committee was charged of establishing guidelines on the use of first-generation HCV PIs in these patients. This scientific committee based its work on preliminary results from tritherapy clinical trials in co-infected patients and, since data on these patients are still scarce, on the statements already made by the French Association for the Study of the Liver (AFEF)

on the use of tritherapy in HCV mono-infected patients, written in May 2011 and updated in 2012. Each AFEF guideline concerning HCV mono infection was examined in order to determine whether it could be used in the context of HIV/HCV coinfection.

Results

These guidelines are addressed for the treatment of coinfected patients with various profiles, including treatment-naïve or patients with failure to previous bitherapy and mention those patients for whom tritherapy should start or those for whom it should be delayed. Preliminary results of triple therapy as well as factors associated to virological response are also discussed. Other issues include virological monitoring, clinical and virological criteria to stop therapy, practical treatment management, treatment adherence and the management of side effects and interactions with antiretroviral drugs. These guidelines were submitted for critical review to independent experts.

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