Orthoptic liver transplantation (OLT) of patients coinfected with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) is increasing in frequency in the era of antiretroviral treatment (1). The outcome is however not well defined. Thus, in two small recent survival analyses conflicting results were reported regarding outcome (2,3). Only scarce information regarding anti-HCV treatment posttransplant was given. We here report our experience with two patients. The patients were both male (48 and 55 years old) hemophiliacs, HIV and HCV-end stage cirrhosis, with HCV genotype 1. Both were on HIV treatment, case 1 and 2 had a CD4 cell count of 300 and 350, respectively, and both had HIV-RNA levels <50. None was given HCV treatment before OLT. Case 1 underwent OLT January 2001. Postoperatively he fared well but a protocol biopsy of the liver after 1 year showed a rapid fibrosis evolution with grade III and stage III. He was then started on treatment with pegylated interferon alfa-2a (Pegasys) 180 μg subcutaneously once a week and ribavirin (Rebetol) 800 mg daily. During treatment he had side effects, mainly fatigue and depression, and he was given blood transfusions once a month from treatment week 16 and onwards. Pretreatment HCV-RNA levels were 3.1×106/mL, which decreased to 16.000 IE/mL at treatment week 12 and to undetectable levels (<50 IE/mL) from week 24 and onwards. Due to his slow response treatment was prolonged to a 1 year and 5 months. Posttreatment he continued to have undetectable HCV-RNA levels at 3 and 6 months. By standard definitions he is cured from hepatitis C. Case 2 underwent OLT in 1998. He fared well postoperatively without any major complications. He showed severe changes in a protocol biopsy of the liver after 3 years, grade II-III and stage III. He was treated with pegylated interferon alfa-2a 180 μg subcutaneously once a week and ribavirin 800 mg daily, reduced to 600 mg due to anemia from treatment week 4. Apart from anemia the most disturbing side effect was fatigue. He was treated for 1 year and 5 months and responded similarly to case 1 but relapsed 3 months posttreatment and is now retreated with interferon and ribavirin. Both patients were maintained on antiretroviral and immunosuppressive therapy with no changes throughout the hepatitis C treatment. The anti-HCV treatment regimens are becoming increasingly effective. There is however limited experience regarding treatment of HCV infected patients post-OLT, and for coinfected patients, there are no defined guidelines regarding treatment in that setting. Regarding the patients here reported, both had several strong factors associated with an unfavorable response to hepatitis C treatment. Therefore, case 1 is encouraging. Apart from having a difficult-to-treat genotype, he also had the disadvantage of being immunosuppressed and of being co-infected with HIV. No conclusions can be drawn from only two patients, but the difference in treatment response between them is intriguing and difficult to explain since there are no obvious differences in pretreatment variables or treatment regimen. Anemia was the most disturbing side effect but was manageable with transfusions or dose reductions. Patients coinfected post-OLT should be evaluated for anti-HCV treatment. It is desirable that information is gathered in larger patient cohorts. Robert Schvarcz Department of Infectious Diseases, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden Gunnar Soderdahl Department of Transplantation Surgery, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden