Phase III studies of boceprevir and telaprevir with Peg-IFN and RBV are ongoing, and the medications are not yet U.S. Food and Drug Administration approved for use in HIV/HCV-coinfected persons. Nonetheless, Torin 1 molecular weight current guidelines support the use of HCV protease inhibitors with Peg-IFN and RBV for genotype 1 HCV-infected persons who need therapy and for whom drug interactions

can be managed (http://aidsinfo.nih.gov/guidelines).[12, 48] There are also studies underway to evaluate the efficacy of other direct-acting HCV agents for treatment of HIV/HCV-coinfected persons. In one study, simeprevir (150 mg once-daily) was given for 12 weeks with Peg-IFN and RBV, which was then extended for variable durations up to 48 weeks in total. Patients who had never been treated before or who had relapsed after Peg-IFN and RBV and who were undetectable at 4 weeks of simeprevir, Peg-IFN, and RBV were randomized to 24 or 48 total weeks of treatment (response guided). Patients with previous null or partial response or cirrhosis were given 48 weeks of treatment. In a preliminary report, SVR12 was reported in 77% in the naïve and relapse groups.[49] Another HCV protease inhibitor, faldaprevir, has been studied in HIV/HCV-coinfected patients. In one arm, patients received faldaprevir (120 mg daily),

Peg-IFN, and RBV for 24 weeks, followed by Peg-IFN and RBV for 24 additional weeks. In the other arm, faldaprevir (240 mg/day) was given, and there was randomization at week 12 to stop faldaprevir versus continuing to week 24. All patients were treated for 48 weeks total,

VX-765 cell line with the balance being with Peg-IFN and RBV. Early virologic responses were >80%.[50] There is also a nonstructural protein 5A (NS5A)-targeting agent (daclatasvir) that is being tested in HIV/HCV-coinfected patients. Studies of drug-drug interactions (DDIs) in healthy volunteers examined interactions with daclatasvir and the antiretroviral agents, atazanavir, efavirenz, and tenofovir. Daclatasvir Florfenicol did not affect levels of the antiretrovirals in a clinically significant manner. However, daclatasvir levels were altered when coadministered with boosted atazanavir or efavirenz.[51] This interaction led to the predicted need for dose adjustment of daclatasvir in clinical trials. These trials are currently underway. All patients get daclatasvir, Peg-IFN, and RBV for 24 weeks. There is a response-guided randomization that can occur in one arm with those who are HCV RNA undetectable at weeks 4 and 12 randomized to a total of 24 or 48 weeks of treatment. The other arm receives the final 24 weeks with Peg-IFN and RBV. The HCV nucleotide inhibitor, sofosbuvir, is also being evaluated in HIV/HCV-coinfected patients (www.ClinicalTrials.gov). In a 30-subject pilot trial of sofosbuvir monotherapy given for 7 days, HCV viral decline was similar to that observed in HCV-monoinfected subjects. A viral decline of approximately 4 log was observed.