In addition, HS may contribute to poorer response to interferon-based therapy against HCV. Cumulative exposure to dideoxynucleoside analogs and, perhaps, to efavirenz are factors Akt inhibitor associated with HS progression. Because of this, antiretroviral drugs with less potential impact on mitochondrial toxicity should be prioritized in HIV/HCV-coinfected patients. Finally, the natural history of HS and steatohepatitis in HIV/HCV coinfection needs further investigation, particularly in patients receiving the newer antiretroviral drugs. Additional Supporting Information may be found in the online version of

this article. “
“Human hematopoietic cell transplantation (HCT) is now a standard procedure for many patients with hematologic malignancy and genetic disorders. The path from experimental to standard procedure has been difficult, as mortality

in the early days was very high and the biology of transplant-related problems was so complex that improvement in outcomes had to wait for deeper scientific knowledge. Liver complications have become far less frequent because we now BVD-523 understand how to prevent and treat most of the serious hepatobiliary problems.1, 2 In the online Supporting Information, I have provided three color plates of histologic findings, a brief discussion of indications for transplant and how HCT is carried out (Supporting Appendix 1), a glossary of common terms (Supporting Appendix 2), a list of abbreviations (Supporting Appendix 3), and a topic-oriented reading list (Supporting Appendix 4). ALT, alanine aminotransferase; AML, acute myeloid leukemia; AST, aspartate aminotransferase; CY, cyclophosphamide; BCV, carmustine/cyclophosphamide/etoposide; BU, busulfan; EBV, Epstein-Barr virus; GVHD, graft-versus-host disease; HBsAg, medchemexpress hepatitis B surface antigen; HBV, hepatitis B virus; HCV, hepatitis C virus; HCT, hematopoietic

cell transplantation; MRI, magnetic resonance imaging; SOS, sinusoidal obstruction syndrome; TBI, total body irradiation; VZV, varicella zoster virus. Hepatic fungal infection should be sought in transplant candidates with tender hepatomegaly, fevers, and abnormal liver enzymes, using high-resolution computed tomography or magnetic resonance imaging, fungal biomarkers (galactomannan and glucan assays), and liver biopsy. Miliary fungal lesions are too small to be imaged. Fungal liver infection should be controlled before transplant with caspofungin, micafungin, or posaconazole until engraftment, which can then effect resolution of intractable fungal abscesses.3 Patients without evidence of fungal liver abscesses at baseline routinely receive fluconazole, itraconazole, or voriconazole to prevent liver infections. Hepatitis B and hepatitis C will be transmitted from viremic donors to transplant recipients.