The updated version of JSH Guidelines for Management of Hepatitis C Virus Infection (version 7) was published in June, 2019. Sofosbuvir/velpatasvir (SOF/VEL) without ribavirin for 12 weeks was recommended for decompensated cirrhosis. Glecaprevir/pibrentasvir for 12 weeks or SOF/VEL with ribavirin for 24 weeks was recommended for retreatment of patients with prior failure by direct-acting antiviral (DAA) regimen. For retreatment of genotype 1, determination of RAS, especially P32 deletion in NS5A, was recommended. Recent evidences regarding the risk of hepatocellular carcinoma occurrence or recurrence after DAA therapy and the current status of hepatitis C virus infection treatment after liver transplantation has been described.

A 53-year-old man was diagnosed with cirrhosis related to hepatitis C virus (Child-Pugh score B). Annual blood tests revealed no liver dysfunction. He subsequently developed recurrent fever without an obvious source of infection and received multiple courses of antibiotics. One year later, he was admitted to our hospital with high fever and ascites. Blood test results indicated decreased liver function (Child-Pugh score C) and a systemic inflammatory response. Because he did not respond to symptomatic treatment, liver transplantation was considered. However, HBV-DNA was detected, and a serological test revealed that he was positive for the anti-HIV antibody. Therefore, HCV, HBV, and HIV coinfection was revealed. His condition worsened, and he died 18 months after his first visit. Hepatologists should consider HIV coinfection, especially in young people with chronic hepatitis C that deteriorated into severe hepatitis.

A 41-year-old woman presenting with putative drug-induced severe skin rash and dyspnea was admitted to a nearby hospital. Despite the administration of 50 mg/day of prednisolone (PSL) and 600 mg/day of ursodeoxycholic acid (UDCA), her symptoms did not improve. Liver injury was also noted, and thus, she was transferred to our hospital. Immunosuppressive therapy and UDCA were continued, and the dose of PSL was gradually tapered, which resulted in the gradual improvement of skin symptoms. The liver injury relapsed on the 15th day after the onset of symptoms, and the patient tested positive for human herpesvirus 6 (HHV-6) variant B. These findings indicate that HHV-6 reactivation could be associated with drug-induced hypersensitivity syndrome (DIHS). Therefore, HHV-6 reactivation and DIHS should be considered when drug-induced severe skin rashes and liver injury are observed in a patient.