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High need to switch cART or co-medication with the initiation of DAAs in elderly HIV/HCV co-infected patients.

BACKGROUD
To describe the use of non-antiretroviral co-medication and combination antiretroviral therapy (cART) in HIV/hepatitis C virus (HCV) co-infected patients, and to predict the potential for drug-drug interactions (DDIs) with direct-acting antivirals (DAAs) against HCV.


METHODS
This is a retrospective, cross-sectional study, using the Dutch nationwide ATHENA observational HIV cohort database. All patients with a known HIV/HCV co-infection on 1 January 2015 were included. Co-medication and cART registered in the database were listed. The potential for DDIs between DAAs and co-medication/cART were predicted, using http://hep-druginteractions.org. DDIs were categorized as: (1) no clinically relevant DDI; (2) possible DDI; (3) contra-indication; or (4) no information available.


RESULTS
We included 777 patients of whom 488 (63%) used non-antiretroviral co-medication. At risk for a category 2/3 DDI with non-antiretroviral co-medications were 299 patients (38%). Most DDIs were predicted with paritaprevir/ritonavir, ombitasvir ± dasabuvir (47% of the drugs) and least with grazoprevir/elbasvir (11% of the drugs).Concerning cART, daclatasvir/sofosbuvir is the most favourable combination as no cART is contra-indicated with this combination. In genotype 1/4 patients grazoprevir/elbasvir is least favourable as 75% of the patients must alter their cART.


CONCLUSIONS
This study showed that co-medication use in the aging HIV/HCV population is frequent and diverse. There is a high potential for DDIs between DAAs and co-medication/cART.