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,( Perronne C, Carrat F, Banisadr F, Morand P, Lunel F, Rosental E,et al: ANRS HCO,-RIBAVIC : a randomized controlled trial of pegylated-interferon alfa-,b plus riba- virin vs interferon alfa-,b plus ribavirin for the initial treatment of chronic hepatitis C in HIV co-infected

patients..,nd Interscience Conference on Antimicrobial Agents and Chemotherapy. San Diego, September,,**,, abstract H-+*2-.

-( Lafeuillade A, Hittinger G, Chadapaud S : Increased mitochondrial toxicity with ribavirin in HIV/HCV coinfection. Lancet,**+,-/1:,2*῏,2+,,**+.

.( ¬k­®¯°±²³´: HCVœHIV)J HCV2µ£p¶·H¸¹J°1ºY»¼V1a- ,b./0.12jHIJ²³ª ,**-. /( Bonnet F, Bonarek M, Abridj A, Mercie P, Dupon M,

Gemain MC, Malvy D, Bernard N, Pellegrin JL, Morlat P, Beylot J : Severe lactic acidosis in HIV-infected patients treated with nucleosidic reverse transcriptase analogs : a report of3cases. Rev Med Interne,.:0῏++,,**-. 0( Fortgang IS, Belitsos PC, Chaisson RE, Moore RD :

Hepatomegaly and steatosis in HIV-infected patients re- ceiving nucleoside analog antiretroviral therapy. Am J Gastroenterol3*:+.--῏+.-0,+33/.

1( Cote HC, Brumme ZL, Craib KJ, Alexander CS, Wynhoven B, Ting L, Wong H, Harris M, Harrigan PR, O’Shaughnessy MV, Montaner JS : Changes in mitochon- drial DNA as a marker of nucleoside toxicity in HIV- infected patients. N Engl J Med+.;-.0(++) :2++῏2,*, ,**,.

2( Arenas-Pinto A, Grant AD, Edwards S, Weller IV : Lactic acidosis in HIV infected patients : a systematic review of published cases. Sex Transm Infect 13 (.) :-.*῏-.-, ,**-.

3( Brau N : Update on chronic hepatitis C in HIV/HCV- coinfected patients : viral interactions and therapy.

AIDS+1:,,13῏,,3*,,**-.

+*( Balzarini J, Lee CK, Herdewijn P, De Clercq E : Mech- anism of the potentiating e#ect of ribavirin on the activ- ity of,῍,-῍-dideoxyinosine against human immunodefici- ency virus. J Biol Chem-,:,+/*3῏,+/+.,+33+. ++( Conference Reports for NATAP. +*th Conference on

Retroviruses and Opportunistic Infections Boston, Mass, Feb+*῏+.,,**-.

& .+ (

.+

Fatal Hepatic Failure in a Hemophilia A Patient with HIV/HCV Co-infection

Susumu S

, Satoshi H

, Masahiro O

, Rena M

, Masayoshi D

, Mitsuteru N

, Yuji O

,

Koh I

, Makoto C

, Takeshi K

, Shuhei H

, Toshiko O

, Keiko W

, Akihiro I

and Masahiro A

+῍Third Department of Internal Medicine, Hokkaido University Hospital

,῍First Department of Pathology, Hokkaido University, School of Medicine

Objective: In Japan, most people who have infection with HIV also have infection with HCV caused by administration of coagulation factor products. Fatal lactic acidosis rarely occurs in patients with HIV/HCV co-infection while using both HAART drugs and rivabirin. We experienced a patient with fatal hepatic failure following lactic acidosis after the use of both HAART drugs and rivabirin. We report this rare case with discussion of the results of postmortem examination.

Case Report: A-/-year-old man infected with HIV and HCV after administration of blood products for hemophilia A was started on anti-retroviral therapy for HIV in+33*. He was treated with d.T῎ddI῎PI (RTV῎LPV) from January ,**- after several changes of anti-retroviral drugs. From September,**-, IFNaand ribavirin were also administered for treatment of HCV hepatitis. Symptoms of lactic acidosis initially appeared in October.

Although the above-described medication was stopped and treatment for lactic acidosis, including intravenous administration of sodium bicarbonate, was started immediately, hepat- ic insu$ciency rapidly progressed and he died in November,**-.

Conclusion: In this case, rapidly progressing hepatic insu$ciency was induced by lactic acidosis. We concluded that hepatic failure was possibly caused by lactic acidosis, side e#ects of combined therapy with IFNaand ribavirin, and rapid progression to non-compensative liver cirrhosis from HCV hepatitis.

Key words: HIV infection, HCV infection, ribavirin, lactic acidosis, NRTI

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