title: Use of first-generation HCV protease inhibitors in patients coinfected by HIV and HCV genotype 1.
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 monoinfection was examined 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.
authors.affiliation: Paris Descartes University, Paris, France; APHP, Department of Internal Medicine, Infectious Diseases Unit, Cochin Hospital, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Salmon-Ceron
authors.forename: Cédric
authors.initials: C
authors.lastname: Arvieux
authors.forename: Marc
authors.initials: M
authors.lastname: Bourlière
authors.forename: Patrice
authors.initials: P
authors.lastname: Cacoub
authors.forename: Philippe
authors.initials: P
authors.lastname: Halfon
authors.forename: Karine
authors.initials: K
authors.lastname: Lacombe
authors.forename: Georges-Philippe
authors.initials: GP
authors.lastname: Pageaux
authors.forename: Gilles
authors.initials: G
authors.lastname: Pialoux
authors.forename: Lionel
authors.initials: L
authors.lastname: Piroth
authors.forename: Isabelle
authors.initials: I
authors.lastname: Poizot-Martin
authors.forename: Eric
authors.initials: E
authors.lastname: Rosenthal
authors.forename: Stanislas
authors.initials: S
authors.lastname: Pol
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D060085:Coinfection; D004347:Drug Interactions; D024882:Drug Resistance, Viral; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005838:Genotype; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D016174:Hepacivirus / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics; D006526:Hepatitis C / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D011480:Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D017361:Viral Nonstructural Proteins / Q000037:antagonists & inhibitors* / Q000378:metabolism
chemical_list: D000998:Antiviral Agents; D011480:Protease Inhibitors; D017361:Viral Nonstructural Proteins
keywords: HCV genotype 1; HIV/HCV coinfection; Protease inhibitors