Case report Cure of chronic hepatitis C virus infection in an HIV-coinfected patient with multiple comorbidities and drug interaction challenges Hortensia A ´ lvarez 1 , Ana Marin ˜o 1 , Nieves Valcarce 2 , Saye Khoo 3 , Sanjay Bhagani 4 , Jonathan Schapiro 5 and Josep M Llibre 6 Abstract Curing hepatitis C virus (HCV) infection in patients harbouring multiple severe comorbidities is a medical challenge. Evidence-based data are lacking regarding HCV treatment with direct-acting antiviral regimens in particular popula- tions of HCV/HIV-coinfected patients with cirrhosis and chronic kidney disease on haemodialysis. Here, we present the HCV treatment challenges facing a patient with HIV coinfection, prior failure of both HIV-1 and HCV therapy, cirrhosis, end-stage renal failure on haemodialysis, as well as management of drug–drug interactions, especially given the need to receive long-term amiodarone therapy. Keywords Antiviral, antiretroviral therapy, hepatitis C, human immunodeficiency virus Date received: 2 October 2017; accepted: 4 January 2018 Introduction Curing hepatitis C virus (HCV) infection in patients harbouring multiple severe comorbidities is a medical challenge involving expert teams from multiple medical specialties. Here, we present a patient with HCV/human immunodeficiency virus (HIV) coinfection, cirrhosis, end-stage chronic kidney disease (CKD) on haemo- dialysis and heart disease on amiodarone therapy (clinical characteristics overview shown in Figure 1). A direct-acting antiviral (DAA) regimen for the treatment of HCV was considered. Pre-treatment considerations Some issues were raised relating to HCV/HIV coinfection, with cirrhosis and severe CKD in the background, of the limited number of DAAs that have been trialled in this population. A concerning drug–drug interaction (DDI) existed between DAAs and antiretroviral treatment (ART). At the time of presentation, the patient received once-weekly tenofovir disoproxil fumarate (TDF) (post-haemodialysis) plus twice-daily darunavir (600 mg), ritonavir (100 mg) and raltegravir (400 mg). Her compiled drug-resistance genotype testing revealed reverse transcriptase M184V and Y181C mutations, 1 Infectious Diseases Unit, Internal Medicine Department, University Hospital of Ferrol, A Corun ˜a, Spain 2 Hospital Pharmacy, University Hospital of Ferrol, A Corun ˜a, Spain 3 Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK 4 Department of Infectious Diseases/HIV Medicine, Royal Free London Foundation Trust, London, UK 5 National Hemophilia Center, Sheba Medical Center, Ramat Gan, Israel 6 Infectious Diseases and “Lluita contra la SIDA” Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain Corresponding author: Hortensia A ´ lvarez, Infectious Diseases Unit, Internal Medicine Department, University Hospital of Ferrol, Avda. da Residencia, s/n, 15405, Ferrol, A Corun ˜a, Spain. Email: hortensia.alvarez.diaz@sergas.es International Journal of STD & AIDS 0(0) 1–4 ! The Author(s) 2018 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0956462418755537 journals.sagepub.com/home/std