CIHR Canadian HIV Trials Network Coinfection and Concurrent Diseases Core: Canadian guidelines for management and treatment of HIV/hepatitis C coinfection in adults.
BACKGROUND
Hepatitis C virus (HCV) coinfection occurs in 20% to 30% of Canadians living with HIV, and is responsible for a heavy burden of morbidity and mortality. HIV-HCV management is more complex due to the accelerated progression of liver disease, the timing and nature of antiretroviral and HCV therapy, mental health and addictions management, socioeconomic obstacles and drug-drug interactions between new HCV direct-acting antiviral therapies and antiretroviral regimens.


OBJECTIVE
To develop national standards for the management of HCV-HIV coinfected adults in the Canadian context.


METHODS
A panel with specific clinical expertise in HIV-HCV co-infection was convened by The CIHR HIV Trials Network to review current literature, existing guidelines and protocols. Following broad solicitation for input, consensus recommendations were approved by the working group, and were characterized using a Class (benefit verses harm) and Level (strength of certainty) quality-of-evidence scale.


RESULTS
All HIV-HCV coinfected individuals should be assessed for HCV therapy. Individuals unable to initiate HCV therapy should initiate antiretroviral therapy to slow liver disease progression. Standard of care for genotype 1 is pegylated interferon and weight-based ribavirin dosing plus an HCV protease inhibitor; traditional dual therapy for 24 weeks (for genotype 2/3 with virological clearance at week 4); or 48 weeks (for genotypes 2-6). Therapy deferral for individuals with mild liver disease may be considered. HIV should not be considered a barrier to liver transplantation in coinfected patients.


CONCLUSIONS
Recommendations may not supersede individual clinical judgement.
University of British Columbia, British Columbia Centre for Excellent in HIV/AIDS, Vancouver, British Columbia;
Mark
M
Hull
McGill University, Montréal, Quebec;
Marina
M
Klein
University of Alberta, Edmonton, Alberta;
Stephen
S
Shafran
Toronto General Hospital, Toronto;
Alice
A
Tseng
The Ottawa Hospital Research Institute, Ottawa, Ontario;
Pierre
P
Giguère
Clinique médicale du Quartier Latin, Montréal, Quebec;
Pierre
P
Côté
Clinique médicale du Quartier Latin, Montréal, Quebec;
Marc
M
Poliquin
University of Ottawa, Ottawa, Ontario.
Curtis
C
Cooper
Antivirals; Direct-acting antivirals; HCV; HIV; Pharmacokinetics