title: CIHR Canadian HIV Trials Network Co-Infection and Concurrent Diseases Core: Updated Canadian guidelines for the treatment of hepatitis C infection in HIV-hepatitis C coinfected adults.
abstract: 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. Management of HIV-HCV coinfection 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 update national standards for the management of HCV-HIV coinfected adults in the Canadian context.
  
  
  METHODS
  A standing working group with specific clinical expertise in HIV-HCV coinfection was convened by The Canadian Institute of Health Research HIV Trials Network to review recently published data regarding HCV antiviral treatments and to update the Canadian HIV-HCV coinfection guidelines.
  
  
  RESULTS
  Recent data suggest that the gap in sustained virological response rates between HCV monoinfection and HIV-HCV coinfection has been eliminated with newer HCV antiviral regimens. All HIV-HCV coinfected individuals should be assessed for HCV therapy. First-line treatment for genotypes 1 through 6 includes pegylated interferon and weight-based ribavirin dosing plus the nucleotide sofosbuvir for 12 weeks. Sofosbuvir in combination with the protease inhibitor simeprevir is another first-line consideration for genotype 1 infection. Sofosbuvir with ribavirin for 12 weeks (genotype 2) and 24 weeks (genotype 3) is also recommended as first-line treatment.
  
  
  CONCLUSIONS
  Recommendations may not supersede individual clinical judgement.
authors.affiliation: University of British Columbia, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia;
authors.forename: Mark
authors.initials: M
authors.lastname: Hull
authors.affiliation: University of Alberta, Edmonton, Alberta;
authors.forename: Stephen
authors.initials: S
authors.lastname: Shafran
authors.affiliation: Toronto General Hospital, Toronto;
authors.forename: Alice
authors.initials: A
authors.lastname: Tseng
authors.affiliation: The Ottawa Hospital, Ottawa, Ontario;
authors.forename: Pierre
authors.initials: P
authors.lastname: Giguère
authors.affiliation: McGill University, Montreal, Quebec;
authors.forename: Marina B
authors.initials: MB
authors.lastname: Klein
authors.affiliation: University of Ottawa, Ottawa, Ontario.
authors.forename: Curtis
authors.initials: C
authors.lastname: Cooper
keywords: Antivirals; Coinfection; HCV; HIV; Treatment; Updated guidelines