By B.J. Caldwell, Educator

For those people infected with both HIV and Hepatitis C, the treatment of their Hep C just got a bit more complicated. With the two new powerful and effective drugs that recently hit the market to treat Hep C, the likelihood of curing Hep C in more people has become a reality. With telaprevir (a protease inhibitor itself) we were already aware of quite a few interactions with HIV  ritonavir-boosted protease inhibitors that made that drug not ideal for many people on HIV treatment. Boceprevir, the other new Hep C drug, initially had much fewer HIV related drug-drug interactions making it seem the better choice for those coinfected with Hep C and HIV.

Merck, the makers of boceprevir, recently sent out a "Dear Dr." letter to physicians regarding some new results showing that it, too, had some significant interactions with ritonavir-boosted HIV protease inhibitors. Merck now does not recommend using boceprevir with ritonavir-boosted HIV PIs.

This means that, currently, there is no optimal Hep C protease inhibitor for HepC/HIV coinfected patients, especially those on a ritonavir-boosted PI for their HIV treatment. It also shows why careful assessment of coinfected people is critical ---- many coinfected people are stable enough to wait until the next wave of Hep C drugs coming down the pipeline. And there have been some AMAZING early results with drugs currently in testing (as presented at the annual AASLD conference late last year). Breathtaking, really. More on those later!