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  1. M E CRAMP
  1. Institute of Liver Studies
  2. Kings College Hospital
  3. London SE5 9RS, UK

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Most people infected with hepatitis C virus (HCV) develop a chronic infection with persistent viraemia and are at risk of progressive liver damage. However, the outcome of chronic HCV infection is extremely variable and is influenced by many factors, including HCV genotype, HCV viral load, route of infection, age at infection, sex, and alcohol consumption. Ultimately, it is the progression to cirrhosis that is the key determinant of both morbidity and mortality1 and a better understanding of additional influences likely to promote this development is needed.

Both hepatitis B virus (HBV) and HCV are transmitted parenterally and coinfection is not uncommon, particularly in intravenous drug users and in countries with a high prevalence of HBV infection.2Coinfection with evidence of chronic HBV and HCV seems to result in more severe liver disease than either infection alone,3with an increased risk of liver cancer2 and probably an increased risk of fulminant hepatitis when superinfection with HCV occurs on the background of chronic HBV.4

The presence of hepatitis B surface and/or hepatitis B core antibodies (anti-HBs and …

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