Evaluation of direct-acting antivirals and antiretroviral therapy for HIV-HCV coinfected patients in the United States
Rivera, Josef Kyle Concepcion
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The human immunodeficiency virus (HIV)-hepatitis C virus (HCV) coinfection is one of the most common coinfections across the globe. There are over 2 million people living with both HIV and HCV worldwide. In the United States, HIV-HCV coinfections present a huge public health issue. There are several risk factors associated with developing this coinfection. One of the greatest risk factors is injection drug use and the practice of sharing needles. With the advent of the opioid epidemic, the number of people contracting both infections have skyrocketed. Despite the large prevalence rate, people with HIV-HCV coinfections can be treated for both infections. Medical professionals have begun successfully controlling HIV infections through antiretroviral therapies and treatments. These HIV regimens have worked well to increase the cluster of differentiation 4 (CD4) cell counts to manageable levels in many patients. Clinicians have used several different HIV medications that are easily categorized into five separate categories: nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, integrase strand transfer inhibitors, protease inhibitors, and C-C chemokine receptor type 5 (CCR5) antagonists. Of these medications, nucleoside reverse transcriptase inhibitors and protease inhibitors have been commonly used with direct-acting antivirals. Like antiretroviral treatments, these direct-acting antivirals (or HCV regimens) have been largely successful in reducing HCV ribonucleic acid (RNA) levels and effectively “curing” the HCV infection. However, some serious complications occurred in several cases because of drug-drug interactions between antiretroviral and direct-acting antiviral medications. This study was dedicated (1) to exploring the many benefits that these medications have for coinfected patients and (2) to analyzing the significant consequences of these drug-drug interactions. To achieve both goals, a review of various research studies, websites, and textbooks was instigated through PubMed, Google Scholar, and the Boston University library system. The resulting research studies spanned a period from the 1980s to the 2010s. The implications from these sources suggest that more extensive testing of medications, regimens, and drug combinations is needed to allow for a more individualized and simplified HIV-HCV treatment plan for each patient. Additional testing may also lead to more generalizable findings that could be applied to a large swath of the population in the United States.