Irrespective of HIV status of a patient, the optimal treatment of hepatitis C virus infection is pegylated interferone alpha or ribavirin (RBV).

However, the management of a patient with HIV/HCV co-infection with epilepsy as a co-morbid state will require optimal caution bearing in mind that such patient may be at risk of drug-related hepatotoxicity and adverse drug interactions involving either ARVs with anti-HCV drugs and/or anti-convulsant drugs. 

It is expected, as a Physician, you must do baseline investigations which include Liver function test, LDH, SEUC, CBC, Hepatitis C viral load in addition to the HIV RNA Viral load and CD4 count mentioned above. The results of these test will play key role in decision-making on how you treat your patient. 

The advocacy is to treat Hepatitis C virus infection before HIV in patients with high CD4 count and low HIV viral load. This is to avoid pill burden , drug toxicity and drug interactions that go with concurrent treatment. I believe your patient will benefit from this option since the HIV viral load is low and CD4 count is high. So ART can be delayed in this case as you monitor the patient's variables.

With serious epilepsy as a co-morbid state, my candid advice is to control (stabilize) the epilepsy with adequate anti-convulsants before you start treatment of the hepatitis C virus infection, because Phenytoin is known for its interaction with drugs metabolized in the liver. You must also ascertain the level of Hep C viremia (viral load) before you institute treatment. If it is low, you may delay the treatment even after controlling the the epilepsy and manage the patient conservatively. 

Since patient has F4 fibrosis, disease is quite advanced and need treatment. The antiepileptics mentioned (except leveteracitam) have significant drug interaction with sofosbuvir, decreasing its blood level. Since sofosbuvir is the cornerstone of  combination DAA regimes for genotype 1 (like ledepasvir, velpatasvir, simeprevir) such therapy may not be effective. A combination which may be tried is ombitasvir+paritaprevir+dasabuvir +/- ribavirin or elbasvir+grazoprevir.

You should consider changing the anticonvulsants with less interacting agents since all options are contrendicated with phenytoin and phenobarbital.

I'd suggest you check the hep interactions database from the university of Liverpool. There are a number of direct acting antiviral she available 

Thanks for the answer, the problem is really complex and in this patient the major question is the drug-drug interactions. The treatment with interferon can lead to frequent and severe side-effects, and this patient had psychiatric comorbidity  (interferon is contraindicated). I agree with Aslihan, we need changing the anticonvulsants with less interacting agents since all options with DAAs are contraindicated with phenytoin and phenobarbital. But this patient was admitted 4 months ago in ICU for refractory seizures, thus the neurologist does not recommend therapeutic changes. What do you recommend?