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A substantial proportion of individuals with chronic hepatitis C virus (HCV) are co-infected with human immunodeficiency virus (HIV). Co-infected individuals are traditionally considered as one of the "special populations" amongst those with chronic HCV, mainly because of faster progression to end-stage liver disease and suboptimal responses to treatment with pegylated interferon alpha and ribavirin, the benefits of which are often outweighed by toxicity. The advent of the newer direct acting antivirals (DAAs) has given hope that the majority of co-infected individuals can clear HCV. However the "special population" designation may prove an obstacle for those with co-infection to gain access to the new agents, in terms of requirement for separate pre-licensing clinical trials and extensive drug-drug interaction studies. We review the global epidemiology, natural history and pathogenesis of chronic hepatitis C in HIV co-infection. The accelerated course of chronic hepatitis C in HIV co-infection is not adequately offset by successful combination antiretroviral therapy. We also review the treatment trials of chronic hepatitis C in HIV co-infected individuals with DAAs and compare them to trials in the HCV mono-infected. There is convincing evidence that HIV co-infection no longer diminishes the response to treatment against HCV in the new era of DAA-based therapy. The management of HCV co-infection should therefore become a priority in the care of HIV infected individuals, along with public health efforts to prevent new HCV infections, focusing particularly on specific patient groups at risk, such as men who have sex with men and injecting drug users.

Surgical site infection (SSI) is a common postoperative complication which leads to significant morbidity and mortality. The aim of antibiotic prophylaxis is to reduce the incidence of SSI by preventing the development of infection due to colonizing or contaminating organisms at the operative site. It is used as an adjunct to, rather than a replacement for, other evidence-based interventions to prevent wound infection, such as the use of skin antiseptics. The choice of antimicrobial agent(s) used is dependent on how clean the operation is, the operative site (which determines the likely organisms), and a variety of patient factors including the presence of allergies and colonization with resistant organisms such as meticillin-resistant Staphylococcus aureus (MRSA). The practicalities of antibiotic prophylaxis administration are discussed. Not all operations require antibiotic prophylaxis; use of antibiotics in any context, including as prophylaxis, can be associated with adverse effects, specifically an increased risk of Clostridium difficile infection (CDI) and resistance development. Prophylaxis should therefore be used responsibly. This article will address some of the common misconceptions about its use and special patient circumstances requiring deviation from the usual guidance.

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