Resources
Pharmacists have several resources that aid in the
detection and explanation of drug-drug interactions with
HCV and HIV medications. Access to drug information
resources such as Lexicomp5 and Micromedex6 is
provided by many employers, and the programs offer
convenient applications for handheld devices. The
University of Liverpool has an extensive free online
interactive drug interaction information system. Users
may select the proposed hepatitis or HIV regimens and
add additional medications to review for interactions.
At the time of publishing, it did not include the two
most recent HCV direct acting antivirals (DAAs) that
were FDA-approved in the US, as the website is based
in the United Kingdom.7, 8 The website also includes fact
sheets on phase III agents in the HCV pipeline. The AIDS
Clinical Trial Group drug interactions database, developed
with the University of Buffalo, offers users free access
to a searchable database with supporting evidence for
HCV/HIV drug interactions with the selected agent.9 An
alternate source must be consulted for non-HCV/HIV
medication interactions. The University of California at
San Francisco maintains a database for HIV medications
that allows users to select a patient’s HIV medication,
and search for interactions by agent, drug class, or all
interactions.10 Prescribers may also use other available
sources; these are examples of sources with information
specific to HCV and HIV.
Conclusion
With the recent approval of new HCV treatment
agents, more providers may engage in HCV care.
Management of antiviral drug interactions for
the HCV/HIV co-infected patient is imperative to
ensure the best chance of achieving SVR while
maintaining suppression of the patient’s HIV viral
load. Pharmacists play an important role in the
management of drug interactions by offering
medication reviews, dosing recommendations, and
advice on therapeutic substitution or dose alteration
for interacting medications in HCV/HIV co-infected
patients. The results of pharmacokinetic studies
as listed in the package insert can provide detailed
information on drug-drug interactions; understanding
drug metabolism can help prescribers anticipate
potential drug-drug interactions that may not be
listed in the package insert. Utilization of drugdrug interaction websites can help clinicians make
decisions about therapy quickly. Pharmacist in
ambulatory clinic, dispensing, and MTM settings
can anticipate, prevent, and respond to drug-