HIV & Hepatitis in the Americas 28–30 April 2016, Mexico City, Mexico

The development of potent interferon‐free regimens of direct‐acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) infection has moved at a remarkable pace. Highly effective, extremely well‐tolerated regimens are now available for most patient populations. Remarkably, advances have moved as quickly for those with HIV–HCV co‐infection as for those with HCV monoinfection, with recent studies showing similar results with most regimens in both populations. This has raised the question of whether HIV co‐infection continues to represent a “special” population among HCV‐infected individuals. There are, however, some data suggesting that HIV may still impair responses in particularly difficult‐to‐cure populations. For example, attempts to shorten therapy to eight weeks with sofosbuvir/NS5A combinations have been at least somewhat less successful in HIV‐co‐infected patients than in those with HCV monoinfection. It is clear that innate and possibly adaptive immune function are still necessary for viral clearance even with highly effective DAA‐based regimens, and thus, it is possible that particularly as therapy is pushed to shorter and simpler combinations, HIV may again emerge as an issue necessitating special consideration. The rationale behind DAA combinations will be reviewed with a focus on relevance for HIV‐HCV co‐infection. A general discussion of remaining issues to be addressed including drug interactions and treatment access will also be included.