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and Hepatitis.com Coverage of the
18th Conference on Retroviruses and
Opportunistic Infections (CROI 2011)
February 27 - March 2, 2011, Boston, MA
Interactions of HIV Meds with HCV drugs Telaprevir and Boceprevir
A substantial number of HIV positive people are coinfected with HCV. To date, most trials of new anti-HCV agents have looked at HCV monoinfected people, but coinfected people have a pressing need for better treatments. The first data from a trial of telaprevir in HIV/HCV coinfected patients was presented this month at the 18th Conference on Retroviruses and Opportunistic Infections (CROI 2011) in Boston.
Researchers at the conference also presented findings from studies looking at interactions between HCV and HIV drugs.
Many antiretroviral drugs are processed by the CYP450 enzyme system in the liver. As such, they can speed up or slow down processing of other agents that use the same enzymes, potentially leading to sub-therapeutic drug levels or intensified side effects.
from Merck presented data on interactions between boceprevir and various
drugs in healthy volunteers. The researchers looked at a set of "probe"
drugs and medications likely to be co-administered to patients with
these findings, the researchers suggested that CYP3A4 and P-glycoprotein
(another drug processing pathway) "do not contribute substantially"
to boceprevir metabolism or elimination. Increased midazolam levels
indicate that boceprevir is a strong reversible CYP3A4 inhibitor.
Rudolph van Heeswijk from Tibotec followed with data on interactions between telaprevir and antiretroviral drugs in healthy volunteers.
(Kaletra), ritonavir-boosted atazanavir
(Reyataz), boosted darunavir
(Prezista), and boosted fosamprenavir
(Lexiva) are both substrates and inhibitors of the CYP3A enzyme,
as is telaprevir, the investigators noted as background. Efavirenz is
an inducer of CYP3A.
these findings, researchers chose 750 mg 3-times-daily telaprevir plus
atazanavir/ritonavir, or telaprevir 1125 mg 3-times-daily with efavirenz
as regimens to evaluate in clinical trials of HIV/HCV coinfected patients.
C Kasserra, E Hughes, M Treitel, et al. Clinical Pharmacology of BOC: Metabolism, Excretion, and Drug-Drug Interactions. 18th Conference on Retroviruses and Opportunistic Infections (CROI 2011). Boston. February 27-March 2, 2011. Abstract 118.
R van Heeswijk,
A Vandevoorde, G Boogaerts, et al. Pharmacokinetic Interactions between
ARV Agents and the Investigational HCV Protease Inhibitor TVR in Healthy
Volunteers. 18th Conference on Retroviruses and Opportunistic Infections
(CROI 2011). Boston. February 27-March 2, 2011. Abstract