295:); and special consideration given to potential for severe drug-drug interactions between the selected medication regimens. When initiating DAA therapy, the individual is typically assessed for ART-naivety. It is recommended that the individual, if not previously already on ART for HIV maintenance, initiate ART 4–6 weeks prior to DAA administration in order to adequately adjust to regimen and provide a greater foundation for efficacious response to HCV treatment.
260:
likelihood to clear the infection. A positive result for a qualitative HCV RNA blood test confirms that the active virus is present in the individual's bloodstream and that the infection is chronic. A negative result can indicate that the person's immune system was able to spontaneously clear their body of the infection without treatment. Lastly, there is an HCV genotype test which is done to identify the particular
251:
Therefore, even if a person is infected with HCV, an HCV Ab test may not show a positive result until after that amount of time has passed. If the HCV Ab test result is positive for HCV antibodies, then the individual either has an active HCV infection or previously had an infection which has since cleared. The individual must follow-up with a quantitative and/or qualitative HCV
237:
window of time after the initial exposure occurred until the test can accurately tell if an individual has been infected or not. One reason for this is because the focus of some of the tests are antibodies. After the initial exposure to the virus, it usually takes 3–4 weeks but it can take up to six months for antibodies to be produced by the body. For
291:) has been shown to preserve immune function, reduce the effects of HIV-related inflammation, and delay hepatic disease. Therefore, treatment plans for individuals with HIV/HCV co-infection include: an initial ART regimen (as recommended for HIV mono-infected individuals); simultaneous HCV treatment involving oral direct-acting antivirals (
284:. Due to higher mortality rates in co-infected individuals as a result of accelerated liver disease – in comparison to individuals with HIV mono-infection – pursuing HCV treatment and cure is a priority in these individuals with optimal suppression of HIV replication and avoidance of drug-drug interactions.
153:, damaged tissue or injection. Common HIV routes of transmission include sharing needles, having unprotected sex with someone who is HIV positive, mother to fetus during pregnancy, being stuck with an HIV-contaminated sharp object, etc. Once the virus has entered the blood stream, it attaches to and enters
250:
For an individual to be diagnosed with HCV, they must first take the hepatitis C antibody (HCV Ab) screening test. This test is used to determine the presence of HCV antibodies in the blood. It can take anywhere from 3–12 weeks after the time of initial exposure for antibodies to appear in the blood.
202:
to occur where an individual gets infected with both viruses at the same time. People who are coinfected with HIV and HCV by way of blood contact are more likely to be infected with HCV before HIV. Studies have shown that in comparison to HIV, there is up to a 10 fold greater risk of transmitting HCV
407:
Over time, liver disease and its complications have arisen as both a morbidity and mortality concern for people with HIV. Studies have determined that co-infection with HIV and HCV is associated with both faster and more severe liver damage than HCV infection alone. In fact, mortality due to liver
378:
At the lowest estimate, there are 35 million individuals infected with HIV and 80 million infected with
Hepatitis C worldwide. With the significant global effect of each of these viruses, it is also important to note that there is a considerable overlap of HIV-positive individuals co-infected with
327:
The Phase 3, multi-center EXPEDITION-2 Study showed that an 8-week treatment in HIV/HCV co-infected individuals with HCV genotype 1, 2, 3, 4, or 6 without cirrhosis provided an overall SVR12 of 100% (136 out of 136 individuals), while a 12-week treatment in HIV/HCV co-infected individuals with HCV
259:
or not. The virus RNA can be detected in the blood 1–2 weeks after exposure. For a quantitative test, a low viral load is any value below <800,000 IU/L and anything above 800,000 IU/L is considered a high viral load. Lower viral loads at the start of treatment have been associated with greater
169:
HCV is transmitted by coming in contact with the blood of someone infected with HCV. The virus is commonly spread by sharing needles, mother to infant during birth, improperly sterilized medical equipment, intercourse with an infected individual, and unregulated tattoos. Once inside the body, the
303:
The overall goal of HCV DAA therapy is to create a
Sustained Virological Response for 12 consecutive weeks (SVR12) to ensure the Hepatitis C virus is not detected in the blood. In clinical trials, the use of the following DAA combinations have shown similar efficacy rates (by achieving SVR12) in
241:
tests, like the viral load blood test, it can take anywhere from 10–33 days for the test to provide an accurate result. If an individual's first HIV test is positive, it is recommended for them to take a second test to confirm the results. If this follow-up test is also positive, an HIV positive
369:
contribute to treatment barriers since these individuals would not be eligible for anti-retroviral therapy. Individuals with continued alcohol/drug/substance abuse and those that exhibit depressive symptoms along with suicidal ideations are also subject to ineligible status for HCV treatment in
236:
and antibodies in the blood. Other tests can detect the presence of the HIV virus by calculating the amount of actual virus present in the blood. None of the tests available can determine if a person is positive immediately after they believe they have been exposed to the virus. Each test has a
423:
The effects of HIV infection on HCV have been widely studied. However, the data on the effects of HCV infection on HIV are conflicting. Some studies show that HCV infection does not affect HIV progression, while others have shown a faster progression of HIV in those co-infected with HCV. When
70:
Although symptoms of HIV and HCV mono-infection have been well-studied over the years, the symptoms associated with HIV and HCV co-infection remain a developing field of research. Many co-infected individuals report a difficulty in attributing their symptoms to a particular viral infection,
123:
blood exposure, sexual intercourse, and mother-to-child transmission. In the United States, injection drug use is known to be the most common mode of transmission of HCV. Some studies have shown that co-infection is significantly associated with older age as well as illicit intravenous and
1318:
Rockstroh JK, Nelson M, Katlama C, Lalezari J, Mallolas J, Bloch M, et al. (August 2015). "Efficacy and safety of grazoprevir (MK-5172) and elbasvir (MK-8742) in patients with hepatitis C virus and HIV co-infection (C-EDGE CO-INFECTION): a non-randomised, open-label trial".
161:, the new viral DNA integrates itself into the host cell's DNA and instructs the cell to produce viral proteins. These viral proteins bud off of the host CD4 cell and move on to infect other CD4 cells which is how the virus spreads in the body and destroys the immune system.
268:) of the HCV virus the individual is infected with. There are a total of six different HCV genotypes. Knowing the specific genotype of the virus is important when deciding on treatment options because some antiviral medications are more effective against certain genotypes.
35:, increasing their risk of morbidity and mortality due to accelerated liver disease. The burden of co-infection is especially high in certain high-risk groups, such as intravenous drug users and men who have sex with men. These individuals who are
71:
indicating an overlap in symptoms of both diseases. This suggests that interventions aiming to reduce the disease burden associated with HIV and HCV co-infection must consist of strategies to manage symptoms of each individual infection.
382:
There are marked differences between groups affected by this co-infection. However, it is consistent that HIV-positive individuals have a higher prevalence of
Hepatitis C infection. Of those co-infected with HIV and HCV, almost 60% are
408:
disease is now one of the top three causes of death in HIV-infected individuals, with 66% of these liver disease-related deaths due to concurrent HCV infection. Additionally, due to the development of novel therapies to treat HIV,
317:, open-label, single-arm C-EDGE CO-INFECTION Study showed that 96% (210 out of 218) of individuals with HCV genotype 1,4, or 6 and HIV co-infection were able to attain SVR12 at the end of the 12-week course of treatment.
379:
HCV. In fact, 20% of HIV-positive individuals also have
Hepatitis C. This overlap is related to the common ways these viruses are spread, including contaminated blood and bodily fluids such as semen and vaginal fluids.
74:
In contrast to HIV and HCV co-infection, there has been significant research delineating the signs and symptoms of each of these individual illnesses. Common symptoms experienced by HIV-infected individuals include
338:
The multi-center, open-label, ION-4 Study showed that a 12-week course of treatment provided an overall SVR12 of 96% (321 out of 335 individuals) in individuals co-infected with HIV and HCV genotype 1 or
182:
and at the end of the whole process, viral proteins are created. These proteins fuse with lipid droplets in the cytosol of the hepatocyte to form a cell known as a high-density HCV precursor. In the
424:
considering this conflicting information, it is important to note that many of these studies were completed before the introduction of antiretroviral therapies for HIV, which are now the
1491:"A comparison of treatment eligibility for hepatitis C virus in HCV-monoinfected versus HCV/HIV-coinfected persons in electronically retrieved cohort of HCV-infected veterans"
1046:"Hepatic decompensation in antiretroviral-treated patients co-infected with HIV and hepatitis C virus compared with hepatitis C virus-monoinfected patients: a cohort study"
361:
Barriers to care exist when discussing therapeutic options for HCV/HIV co-infected individuals. For example, other co-morbidities such as severe hepatic decompensation,
387:, a high risk group for mono-infection with HIV or HCV. Additionally, prevalence varies by geographical location with the highest prevalence of co-infection located in
119:
Due to the similar routes of transmission of HIV and HCV, HIV-positive individuals are at great risk of HIV and HCV co-infection. These routes of transmission include
1356:"Efficacy and Safety of Glecaprevir/Pibrentasvir in Patients Coinfected With Hepatitis C Virus and Human Immunodeficiency Virus Type 1: The EXPEDITION-2 Study"
124:
non-intravenous drug use, and HIV-infected individuals have a higher overall risk of HCV infection irrespective of intravenous drug use or other risk factors.
1216:
111:, and irritability. Co-infected individuals can experience a range of these symptoms, with some studies showing fatigue to be the most prevalent symptom.
190:
which would normally stop the virus from spreading. These lipoviral particles are released out of the hepatocyte to find other hepatocytes to infect.
526:
Johnson MO, Stallworth T, Neilands TB (June 2003). "The drugs or the disease? Causal attributions of symptoms held by HIV-positive adults on HAART".
186:, the HCV precursor cell fuses with two more cells before becoming the HCV lipoviral particle. HCV in this particle form is protected from antibody
1247:"Antiretroviral therapy, interferon sensitivity, and virologic setpoint in human immunodeficiency virus/hepatitis C virus coinfected patients"
618:
1590:
Mandorfer M, Schwabl P, Steiner S, Reiberger T, Peck-Radosavljevic M (May 2016). "Advances in the management of HIV/HCV coinfection".
343:
Due to limited clinical safety data, the following DAA combinations, while available, are not considered as first-line therapies:
1794:
947:
444:
351:
276:
Persons living with an HCV-HIV co-infection are at higher risk for certain adverse medical outcomes, such as accelerated
703:"HIV and HCV coinfection: prevalence, associated factors and genotype characterization in the Midwest Region of Brazil"
1197:. American Association for the Study of Liver Diseases and the Infectious Diseases Society of America. 24 October 2022
1093:
Pineda JA, Romero-Gómez M, Díaz-García F, Girón-González JA, Montero JL, Torre-Cisneros J, et al. (April 2005).
1674:"Prevalence and burden of HCV co-infection in people living with HIV: a global systematic review and meta-analysis"
1191:"HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C – Patients With HIV/HCV Coinfection"
1719:
1224:
328:
genotype 1, 2, 3, 4, or 6 with compensated cirrhosis provided an overall SVR12 of 93% (14 out of 15 individuals).
1136:"Impact of human immunodeficiency virus infection on the course of hepatitis C virus infection: a meta-analysis"
175:
137:
HIV is contracted by coming in contact with the bodily fluids of someone HIV positive. These fluids include
1823:
Mandana
Khalili, MD, University of California San Francisco, HIV InSite Knowledge Base Chapter, March 2006.
1294:
1095:"HIV coinfection shortens the survival of patients with hepatitis C virus-related decompensated cirrhosis"
412:
therapies, HIV-positive individuals are taking chronic medications to prevent the progression of HIV to
1454:"Challenges in the treatment of patients coinfected with HIV and hepatitis C virus: need for team care"
850:
1673:
1217:"HCV/HIV Considerations for Antiretroviral Use in Patients with Coinfections Adult and Adolescent ARV"
1634:
24:
43:
due to shared routes of transmission including, but not limited to, exposure to HIV-positive blood,
1354:
Rockstroh JK, Lacombe K, Viani RM, Orkin C, Wyles D, Luetkemeyer AF, et al. (September 2018).
416:. However, these medications can have negative side effects on the liver, and can therefore worsen
321:
314:
292:
1820:
971:
948:"Hepatitis C RNA Quantitative Testing: Test of Hepatitis C - Viral Hepatitis and Liver Disease"
384:
346:
288:
149:. An individual can become infected with HIV if these fluids enter the bloodstream by way of a
1245:
Balagopal A, Kandathil AJ, Higgins YH, Wood J, Richer J, Quinn J, et al. (August 2014).
626:
332:
187:
179:
158:
104:
1012:
995:
Kirk GD, Mehta SH, Astemborski J, Galai N, Washington J, Higgins Y, et al. (May 2013).
1842:
1190:
307:
281:
1672:
Platt L, Easterbrook P, Gower E, McDonald B, Sabin K, McGowan C, et al. (July 2016).
255:
blood test which provides a count of the HCV viral load and indicates if the infection is
8:
1540:"Barriers to treatment of hepatitis C in HIV/HCV-coinfected adults with alcohol problems"
99:. On the other hand, symptoms associated with HCV infection include fatigue, depression,
54:
Infection with HCV can be asymptomatic, resolve itself without treatment, or can lead to
1403:
Naggie S, Cooper C, Saag M, Workowski K, Ruane P, Towner WJ, et al. (August 2015).
1615:
1564:
1539:
1515:
1490:
1429:
1404:
1380:
1355:
1271:
1246:
1162:
1135:
1070:
1045:
1021:
997:"HIV, age, and the severity of hepatitis C virus-related liver disease: a cohort study"
996:
875:
727:
702:
678:
653:
595:
570:
551:
503:
478:
44:
1689:
1332:
898:
1847:
1800:
1790:
1742:
1693:
1654:
1619:
1607:
1569:
1555:
1520:
1471:
1434:
1385:
1336:
1276:
1167:
1116:
1075:
1044:
Lo Re V, Kallan MJ, Tate JP, Localio AR, Lim JK, Goetz MB, et al. (March 2014).
1026:
880:
732:
701:
Freitas SZ, Teles SA, Lorenzo PC, Puga MA, Tanaka TS, Thomaz DY, et al. (2014).
683:
600:
543:
508:
256:
32:
1650:
718:
555:
1780:
1734:
1685:
1646:
1599:
1559:
1551:
1510:
1502:
1461:
1424:
1416:
1375:
1367:
1328:
1266:
1258:
1157:
1147:
1106:
1065:
1057:
1016:
1008:
870:
862:
775:
750:
722:
714:
673:
665:
590:
582:
535:
498:
490:
425:
277:
265:
825:
228:. To establish the presence of the HIV virus, some tests measure the level of HIV
866:
669:
362:
183:
150:
1785:
1768:
1641:. Twenty-five Years of Antiretroviral Drug Development: Progress and Prospects.
1720:"The burden of liver disease in human immunodeficiency virus-infected patients"
1295:"FAQs about Sustained Virological Response - Viral Hepatitis and Liver Disease"
586:
452:
409:
366:
199:
1603:
539:
1836:
922:
800:
417:
216:
To diagnose an individual with HIV, a test must be taken to determine if the
154:
20:
1538:
Nunes D, Saitz R, Libman H, Cheng DM, Vidaver J, Samet JH (September 2006).
1804:
1746:
1738:
1697:
1658:
1611:
1573:
1524:
1475:
1438:
1389:
1340:
1280:
1171:
1120:
1092:
1079:
1030:
884:
736:
687:
604:
547:
512:
388:
238:
225:
120:
80:
17:
Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) co-infection
1506:
1420:
1371:
494:
396:
392:
146:
40:
654:"Virologic and immunologic aspects of HIV-hepatitis C virus coinfection"
304:
individuals with HIV/HCV co-infection as those with HCV mono-infection:
198:
Since the two viruses can be spread in similar ways, it is possible for
1152:
171:
108:
48:
1262:
1111:
1094:
1633:
Soriano V, Vispo E, Labarga P, Medrano J, Barreiro P (January 2010).
1405:"Ledipasvir and Sofosbuvir for HCV in Patients Coinfected with HIV-1"
1061:
647:
645:
643:
220:
is present in their system. There are several test options including
55:
47:, and passage of the Hepatitis C virus from mother to infant during
1466:
1453:
472:
470:
261:
229:
92:
84:
640:
233:
96:
19:
is a multi-faceted, chronic condition that significantly impacts
1589:
1489:
Butt AA, McGinnis K, Skanderson M, Justice AC (September 2011).
467:
88:
59:
1826:
1769:"HIV-HBV and HIV-HCV Coinfection and Liver Cancer Development"
1317:
477:
Mohsen AH, Easterbrook P, Taylor CB, Norris S (October 2002).
1671:
1488:
1244:
476:
221:
217:
142:
138:
100:
76:
413:
1632:
1353:
569:
Bova C, Jaffarian C, Himlan P, Mangini L, Ogawa L (2008).
568:
1451:
1402:
994:
525:
287:
In individuals living with HIV, anti-retroviral therapy (
252:
36:
28:
1717:
1452:
Fleming CA, Tumilty S, Murray JE, Nunes D (April 2005).
801:"Hepatitis C Questions and Answers for the Public | CDC"
145:, pre-seminal fluid, rectal fluids, vaginal fluids, and
700:
1043:
707:
Revista do
Instituto de Medicina Tropical de Sao Paulo
1537:
575:
The
Journal of the Association of Nurses in AIDS Care
571:"The Symptom Experience of HIV/HCV-Coinfected Adults"
1718:
Puoti M, Moioli MC, Travi G, Rossotti R (May 2012).
1585:
1583:
232:
in the blood and/or saliva or the level of both HIV
1134:Deng LP, Gui XE, Zhang YX, Gao SC, Yang RR (2009).
1580:
851:"Coinfection with HIV-1 and HCV--a one-two punch"
1834:
751:"HIV Transmission | HIV Basics | HIV/AIDS | CDC"
651:
1133:
1544:Alcoholism: Clinical and Experimental Research
826:"Lifecycle - HCV Biology - Hepatitis C Online"
178:. Inside the cell, the viral RNA undergoes
1821:Coinfection with Hepatitis Viruses and HIV
1784:
1563:
1514:
1465:
1428:
1379:
1270:
1161:
1151:
1110:
1069:
1020:
874:
726:
677:
594:
502:
157:(CD4 cells) in order to replicate. After
1766:
1733:(2). Thieme Medical Publishers: 103–13.
848:
652:Chew KW, Bhattacharya D (October 2016).
395:versus the lowest prevalence located in
298:
39:-positive are commonly co-infected with
1013:10.7326/0003-4819-158-9-201305070-00604
203:after contact with an infected needle.
27:(WHO), 2 to 15% of those infected with
1835:
1635:"Viral hepatitis and HIV co-infection"
619:"WHO | HIV and hepatitis coinfections"
1185:
1183:
1181:
445:"WHO: HIV and hepatitis coinfections"
65:
1495:AIDS Research and Human Retroviruses
1829:U.S. Department of Veterans Affairs
1409:The New England Journal of Medicine
849:Kim AY, Chung RT (September 2009).
479:"Hepatitis C and HIV-1 coinfection"
356:
352:Sofosbuvir/Velpatasvir/Voxilaprevir
224:, at-home, saliva, viral load, and
13:
1178:
14:
1859:
1814:
1140:World Journal of Gastroenterology
1556:10.1111/j.1530-0277.2006.00183.x
1760:
1711:
1678:The Lancet. Infectious Diseases
1665:
1651:10.1016/j.antiviral.2009.10.021
1626:
1531:
1482:
1445:
1396:
1347:
1311:
1287:
1238:
1209:
1127:
1086:
1037:
988:
964:
940:
915:
891:
842:
818:
793:
719:10.1590/S0036-46652014000600011
373:
114:
923:"HIV Testing | HIV/AIDS | CDC"
768:
743:
694:
611:
562:
519:
437:
428:for HIV-positive individuals.
280:, hepatic decompensation, and
242:diagnosis can likely be made.
1:
1773:Cancer Treatment and Research
1690:10.1016/S1473-3099(15)00485-5
1333:10.1016/s2352-3018(15)00114-9
431:
370:HCV/HIV co-infected persons.
176:receptor-mediated endocytosis
1827:National Hepatitis C Program
1458:Clinical Infectious Diseases
1360:Clinical Infectious Diseases
867:10.1053/j.gastro.2009.06.040
670:10.1097/QAD.0000000000001203
271:
206:
127:
7:
1786:10.1007/978-3-030-03502-0_9
1779:. Springer, Cham: 231–250.
1767:Hu J, Liu K, Luo J (2019).
1050:Annals of Internal Medicine
1001:Annals of Internal Medicine
10:
1864:
587:10.1016/j.jana.2008.01.003
402:
193:
1727:Seminars in Liver Disease
1604:10.1007/s12072-015-9691-4
170:virus enters the liver's
25:World Health Organization
1592:Hepatology International
322:Glecaprevir/Pibrentasvir
245:
211:
1460:. 40 Suppl 5: S349-54.
540:10.1023/a:1023938023005
1739:10.1055/s-0032-1316473
976:Treatment Action Group
776:"The lifecycle of HIV"
385:intravenous drug users
347:Sofosbuvir/Velpatasvir
164:
132:
1507:10.1089/AID.2011.0004
1421:10.1056/NEJMoa1501315
1195:www.hcvguidelines.org
830:www.hepatitisc.uw.edu
333:Ledipasvir/Sofosbuvir
299:HCV treatment options
159:reverse transcription
105:peripheral neuropathy
31:are also affected by
1299:www.hepatitis.va.gov
952:www.hepatitis.va.gov
495:10.1136/gut.51.4.601
308:Elbasvir/Grazoprevir
282:immune dysregulation
23:. According to the
1639:Antiviral Research
1372:10.1093/cid/ciy220
1153:10.3748/wjg.15.996
66:Signs and symptoms
45:sexual intercourse
1796:978-3-030-03501-3
1263:10.1002/hep.27158
1112:10.1002/hep.20626
664:(16): 2395–2404.
629:on April 18, 2014
528:AIDS and Behavior
1855:
1809:
1808:
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1764:
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1480:
1479:
1469:
1449:
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1442:
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1400:
1394:
1393:
1383:
1366:(7): 1010–1017.
1351:
1345:
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1315:
1309:
1308:
1306:
1305:
1291:
1285:
1284:
1274:
1242:
1236:
1235:
1233:
1232:
1223:. Archived from
1213:
1207:
1206:
1204:
1202:
1187:
1176:
1175:
1165:
1155:
1131:
1125:
1124:
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1084:
1083:
1073:
1062:10.7326/M13-1829
1041:
1035:
1034:
1024:
992:
986:
985:
983:
982:
968:
962:
961:
959:
958:
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938:
937:
935:
934:
919:
913:
912:
910:
909:
895:
889:
888:
878:
855:Gastroenterology
846:
840:
839:
837:
836:
822:
816:
815:
813:
812:
797:
791:
790:
788:
787:
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765:
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762:
747:
741:
740:
730:
698:
692:
691:
681:
649:
638:
637:
635:
634:
625:. Archived from
615:
609:
608:
598:
566:
560:
559:
523:
517:
516:
506:
474:
465:
464:
462:
460:
455:on April 1, 2014
451:. Archived from
441:
426:standard-of-care
357:Barriers to care
278:hepatic fibrosis
1863:
1862:
1858:
1857:
1856:
1854:
1853:
1852:
1833:
1832:
1817:
1812:
1797:
1765:
1761:
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1749:
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1716:
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1666:
1631:
1627:
1588:
1581:
1536:
1532:
1487:
1483:
1450:
1446:
1401:
1397:
1352:
1348:
1321:The Lancet. HIV
1316:
1312:
1303:
1301:
1293:
1292:
1288:
1243:
1239:
1230:
1228:
1215:
1214:
1210:
1200:
1198:
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1188:
1179:
1146:(8): 996–1003.
1132:
1128:
1091:
1087:
1042:
1038:
993:
989:
980:
978:
972:"HCV Genotypes"
970:
969:
965:
956:
954:
946:
945:
941:
932:
930:
921:
920:
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