Preventive Regimen
Indication	First Choice	Alternative	Comments/Special Issues
Primary Prophylaxis	None	N/A	N/A
Secondary Prophylaxis	None	N/A	N/A
Treatment	IFN-α Plus Ribavirin Combination Therapy: Pegylated IFN-α: Peg-IFN 2a 180 µg/1.73 m2 body surface area subcutaneously once per week (maximum dose 180 µg) OR Peg-IFN 2b 60 µg/m2 body surface area once per week PLUS Ribavirin (oral) 7.5 mg/kg body weight twice daily (fixed dose by weight recommended): 25–36 kg: 200 mg a.m. and p.m. >36 to 49 kg: 200 mg a.m. and 400 mg p.m. >49 to 61 kg: 400 mg a.m. and p.m. >61 to 75 kg: 400 mg a.m. and 600 mg p.m. >75 kg: 600 mg a.m. and p.m. Treatment Duration: 48 weeks, regardless of HCV genotype	None	Optimal duration of treatment for HIV/HCV-coinfected children is unknown and based on recommendations for HIV/HCV-coinfected adults Treatment of HCV in children <3 years generally is not recommended. Indications for treatment are based on recommendations in HIV/HCV-coinfected adults; because HCV therapy is more likely to be effective in younger patients and in those without advanced disease or immunodeficiency, treatment should be considered for all HIV/HCV-coinfected children aged >3 years in whom there are no contraindications to treatment For recommendations related to use of telaprevir or boceprevir in adults, including warnings about drug interactions between HCV protease inhibitors and HIV protease inhibitors and other antiretroviral drugs, see Adult OI guidelines. IRIS may be manifested by dramatic increase in transaminases as CD4 cell counts rise within the first 6–12 weeks of cART. It may be difficult to distinguish between IRIS and drug-induced hepatotoxicity or other causes of hepatitis. IFN-α is contraindicated in children with decompensated liver disease, significant cytopenias, renal failure, severe cardiac disorders and non-HCV-related autoimmune disease. Ribavirin is contraindicated in children with unstable cardiopulmonary disease, severe pre-existing anemia or hemoglobinopathy. Didanosine combined with ribavirin may lead to increased mitochondrial toxicities; concomitant use is contraindicated. Ribavirin and zidovudine both are associated with anemia, and when possible, should not be administered together

Key to Acronyms: cART = combined antiretroviral therapy; HCV = hepatitis C virus; IFN = interferon; IRIS = immune reconstitution inflammatory syndrome; Peg-IFN = pegylated interferon; SQ = subcutaneous