Drug-drug interactions between DAAs and ARVs


  Potential increased exposure of DAA
  Potential decreased exposure of DAA
No significant effect
D  Potential decreased exposure of ARV drug
E  Potential elevated exposure of ARV drug

ATV/c    ATV co-formulated with COBI (300/150 mg qd)
DRV/c    DRV co-formulated with COBI (800/150 mg qd)

Numbers refer to decreased/increased AUC as observed in drug interactions studies.
First/second numbers refer to AUC changes for EBR/GZR or GLE/PIB or SOF/LDV or SOF/VEL.
First/second/third numbers refer to AUC changes for SOF/VEL/VOX

Interactions with ZDV
No clinically relevant interactions expected with ZDV and DAAs
Interactions with ibalizumab



  1. DCV should be reduced to 30 mg qd with ATV/c, ATV/r or EVG/c. No dose reduction with unboosted ATV
  2. DCV should be increased to 90 mg qd
  3. Study details are with unboosted ATV. Use only with unboosted ATV (ATV increased PTV exposure due to CYP3A4 and OATP1B1/3 inhibition, not recommended without DSV)
  4. Co-administration decreased DRV trough concentration by ~50%. Although co-administration of DRV with OBV/PTV/r + DSV is not recommended in the US Prescribing Information, the European SmPC advises that DRV (dosed at 800 mg qd and administered at the same time as OBV/PTV/r + DSV) can be used in the absence of extensive HIV PI resistance and should be taken without additional RTV
  5. Not recommended due to increase in PTV exposure when coadministered with DRV 800 mg given with OBV, PTV, RTV (Viekirax). Of note: exposures of PTV greater than this have been evaluated in phase 2 studies and were not expected to have a clinically meaningful impact on safety
  6. Severe tolerability issues
  7. Not recommended unless benefit outweighs the risk due to potential for QT interval prolongation with higher concentrations of RPV. Coadministration should be only considered in persons without known QT prolongation and without other QT prolongation co-medicines
  8. Monitoring of kidney function recommended due to increase of tenofovir concentration if the regimen contains TDF
  9. Study details are with once daily DRV/r. Twice daily DRV has not been studied and should be used with caution as VOX concentrations may increase more than with once daily DRV (this would be of further significance in cirrhotic patients).  Monitoring of kidney function recommended due to increase of tenofovir concentrations if the regimen contains TDF

Further Information
For additional drug-drug interactions and for more detailed pharmacokinetic interaction data and dosage adjustments, please refer to http://www.hiv-druginteractions.org (University of Liverpool)