The topic of perianal infections covers a broad range of illnesses that can be difficult to differentiate from each other. As a result, patients may suffer from unnecessary examinations and ineffective or delayed therapeutic interventions. This article reviews common and unusual infectious pathology and inflammatory or malignant conditions that should be considered in the differential diagnosis. Presentations of infectious pathology specific to HIV are discussed. New treatment strategies, where available, are noted.
The approval of the first direct-acting antiviral (DAA) drugs for treatment of HCV in 2011 has lead to improved sustained viral response (SVR) rates up to 79% in treatment-naïve or relapse genotype 1 (G1) patients, and up to 59% for non-responder G1 patients. This review discusses the clinical skills required for the use of direct-acting anti-viral drugs (DAA), the use of genetic tests and HCV RNA assays, resistance-associated variants (RAV), treatment of special populations, and future directions. The results of the pivotal phase 3 trials with both telaprevir and boceprevir are summarized, including the efficacy, safety and tolerability, drug-drug interactions and management of the most common side-effects. Treatment strategies implemented in order to minimize the development of resistance with these first-generation protease inhibitors are explored. The use of these drugs ushers in a new era for the treatment of HCV but should be done with both care and caution.
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