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Effective and nontoxic new drugs for eradicating hepatitis C virus (HCV) have inspired a well-deserved wave of enthusiasm among clinicians. However, an intriguing pair of case reports suggests these drugs should be used with caution in HCV-positive patients who also are infected with hepatitis B virus (HBV). These two patients, HIV-negative men in their mid-50s, had chronic HBV and HCV genotype 1a infections; HCV treatment with peginterferon plus ribavirin had failed.
One patient had barely detectable HBV DNA (2300 IU/mL) at the beginning HCV treatment with sofosbuvir (Sovaldi) and simeprevir (Olysio). By week 4 after the start of treatment, HCV viral load was undetectable. At week 7, jaundice, abdominal pain, and other evidence of severe vi…