Compensatory substitutions in the HCV NS3/4A protease cleavage sites are not observed in patients treated unsuccessfully with telaprevir combination treatment

HCV enters the twenty-first century

Almost one-third of Americans infected with human immunodeficiency virus (HIV) and 7 million worldwide are coinfected with hepatitis C virus (HCV). The principal route of HCV spread in the US is injection drug use but there are recent reports of outbreaks of acute HCV infection among HIV-infected men who have sex with men. With increased survival as a result of highly active antiretroviral therapy, HCV-associated liver disease has become a leading cause of death in HIV-infected individuals. Currently, telaprevir and boceprevir, both NS3/NS4A inhibitors that significantly improve sustained response when added to pegylated interferon and ribavirin, are approved only for HCV monoinfection. The optimal combination of agents, therapy durations and the timing of treatment remain major challenges in coinfected patients.