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Hepatitis C Virus Infection and Coinfection With Human Immunodeficiency Virus:  Challenges and Advancements in Management

Colleen Hadigan, MD, MPH; Shyamasundaran Kottilil, MD, PhD
JAMA. 2011;306(3):294-301. doi:10.1001/jama.2011.975.
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Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) both emerged in the second half of the 20th century, and chronic infection with these agents is among the greatest challenges facing health care in the United States and worldwide. Despite tremendous advances in treatment and management of HIV and HCV, individuals with HIV/HCV coinfection experience a more complicated disease course and treatment. Recognition of the important role that host factors, such as IL28B genotype, have in response to HCV therapy and the emergence of new effective therapies for HCV are actively reshaping the standard of care. These advances may translate into more effective treatment and management of patients with chronic HCV and HIV coinfection in the years ahead.

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Figure 1. Histopathology Results From Case Patient’s Percutaneous Liver Biopsy Specimens
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A, From a biopsy in 2008, hematoxylin-eosin stain demonstrates moderate portal inflammation, moderate interface hepatitis, and mild steatosis, and Masson stain shows bridging fibrosis (blue). B, Repeat biopsy in 2010 shows hematoxylin-eosin stain demonstrating decreased inflammation and decreased steatosis, and Masson stain showing fibrosis (blue), which is unchanged. Original magnification ×200.

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Figure 2. Target of Nonstructural 3/4A Serine Protease Inhibitors in the HCV Life Cycle
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Nonstructural 3/4A (NS3/4A) serine protease inhibitors are directly acting antiviral agents that interfere with viral NS3 serine protease and its cofactor, NS4A. In the hepatitis C virus (HCV) life cycle, viral NS3/4A serine protease cleaves the HCV polyprotein into small nonstructural proteins that are necessary for viral replication within the hepatocyte. Two drugs in this class, telaprevir and boceprevir, were recently approved by the US Food and Drug administration. ssRNA indicates single-stranded RNA.

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