Table 2: Dosing considerations of the DAAs recommended in current guidelines [13,16,24,25].

DAAs Dose DDI Liver impairment Renal impairment
Ledipasvir/sofosbuvir 1 tablet QD

Contraindicated in patient received amiodarone and rosuvastatin

P-gp inducers ↓ SOF & LDV level

Can be used with most of HIV ARV but LDV ↑TDF level, close monitor renal function or use TAF

No dosage adjustment

No dose adjustment in mild or moderate renal impairment.

No recommended dose in eGFR < 30 ml/min or hemodialysis).

Sofosbuvir/velpatasvir 1 tablet QD

VEL is metabolized by CYP3A4, CYP2C8, CYP2B6.

Avoid use with efavirenz (↓VEL)

VEL ↑TDF level, close monitor renal function or use TAF

Simeprevir plus Sofosbuvir 1 tablet QD

Metabolized by 3A4

Should be avoided with efavirenz, nevirapine, cobicistat, or boosted protease inhibitors

Contraindicated in Child-Pugh B/C
Daclatasvir plus Sofosbuvir 1 tablet QD Avoid use with strong CYP3A4-inducers or -inhibitors No dosage adjustment
Elbasvir/grazoprevir 1 tablet QD

Metabolized by CYP3A4 and substance of P-gp

Avoid use with CYP3A4 and P-gp inducers/inhibitors (HIV protease inhibitors, NNRTI with efavirenz, Nevirapine)

Contraindicated in Child-Pugh B/C No dosage adjustment
Glecaprevir/pibrentasvir 1 tablet QD

Inhibitor of P-gp, BCRP, OATP. Weak inhibitor of CYP3A4, 1A2 and UGT1A1.

Avoid use with HIV protease inhibitors, NNRTI with efavirenz, Nevirapine

Not recommended in Child-Pugh B and contraindicated in Child-Pugh C

No dosage adjustment

Ombitasvir/paritaprevir/r/plus dasabuvir

2 tablets QD plus 1 tablet BID

Metabolized by 3A4/2C8 and also 3A4/2C8 inhibitor

Should be avoided with efavirenz, nevirapine, ritonavir-boosted lopinavir, ritonavir-boosted tipranavir, cobicistat, rilpivirine, darunavir

Contraindicated in Child-Pugh B/C

No dosage adjustment