Table 2.
Specific antiretroviral concerns in HIV/HCV-coinfected persons.
| Drug | Comment | Recommendation | ||
|---|---|---|---|---|
| Abacavir | • | May decrease virologic response to HCV therapy, especially when serum ribavirin levels low, possibly by competing with ribavirin for phosphorylation at an intracellular level [139, 140] | • | Ensure adequate weight-based ribavirin dosing |
| • | Emphasize ribavirin adherence | |||
| Didanosine | • | Can have increased intracellular levels when administered with ribavirin [132] | • | Concomitant use with ribavirin contraindicated |
| • | May be associated with hepatic steatosis in coinfected persons [79] | |||
| • | Increased risk of lactic acidosis and pancreatitis when administered with ribavirin [133–136] | |||
| • | Increased risk of hepatic decompensation during HCV therapy in coinfected patients with cirrhosis [137, 138] | |||
| Nevirapine | • | Increased rate of severe hepatotoxicity in HIV/HCV-coinfected persons [67, 80, 81] | • | Consider alternate antiretroviral agent in coinfected persons |
| • | May be associated with hepatic fibrosis in coinfected individuals [82] | |||
| Stavudine | • | May be associated with hepatic steatosis in HIV/HCV-coinfected persons [79] | • | Consider avoiding use of stavudine, if possible |
| Zidovudine | • | Can potentiate ribavirin-induced anemia, possibly through suppression of hematopoiesis [131] | • | Avoid concomitant use with ribavirin |
| • | Monitor hemoglobin levels closely if no other antiretroviral options | |||