Emtricitabine/Tenofovir-DF (FTC/TDF, PrEP)
Quality of Evidence: Moderate
Coadministration of emtricitabine/tenofovir-DF with ledipasvir/sofosbuvir has been shown to increase tenofovir concentrations, especially when used with an HIV regimen containing a pharmacokinetic enhancer (ritonavir or cobicistat), and also with regimens containing efavirenz or rilpivirine. The safety of increased tenofovir concentrations in these settings has not been established. The potential risks and benefits associated with coadministration should be considered, particularly in patients at increased risk of renal dysfunction. If other alternatives are not available, patients receiving ledipasvir/sofosbuvir concomitantly with tenofovir-DF and a boosted HIV protease inhibitor should be monitored for adverse reactions related to tenofovir-DF. No dose adjustment is recommended for patients receiving ledipasvir/sofosbuvir concomitantly with tenofovir-DF and efavirenz or rilpivirine. The increased exposure of tenofovir could potentiate adverse reactions associated with tenofovir disoproxil fumarate, including renal disorders and renal function should be closely monitored.