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 |
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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 |