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Grand Rounds
July 14, 2004

HIV Infection, Hepatitis C Infection, and HAARTHard Clinical Choices

JAMA. 2004;292(2):243-250. doi:10.1001/jama.292.2.243

Abnormalities in hepatic function have become one of the most common complications occurring among human immunodeficiency virus (HIV)–infected individuals receiving highly active antiretroviral therapy (HAART), and liver disease has become an increasingly important cause of morbidity and mortality in HIV-infected patients. We present a case of a patient with HIV infection and hepatotoxicity that exemplifies the complications currently observed during the treatment of such patients. Hepatotoxicity can be a result of several factors, including a direct effect of HAART, substance abuse, and coinfection with either hepatitis C virus (HCV) or hepatitis B virus. Imaging studies may be helpful in determining the etiology; however, a liver biopsy is often necessary to be able to more accurately determine the relative contributions of different processes. Although coinfection with HCV and HIV has become a common clinical problem, optimal treatment of such patients remains to be defined and must be individualized to maximize benefit and tolerance.