Real-World Clinical Efficacy and Tolerability of Direct-Acting Antivirals in Hepatitis C Monoinfection Compared to Hepatitis C/Human Immunodeficiency Virus Coinfection in a Community Care Setting

BACKGROUND/AIMS: Limited data exist comparing the safety and efficacy of direct-acting antivirals (DAAs) in hepatitis C virus (HCV) monoinfected and HCV/human immunodeficiency virus (HIV) coinfected patients in the real-world clinic practice setting. METHODS: All HCV monoinfected and HCV/HIV coinfected patients treated with DAAs between January 2014 and October 2017 in community clinic settings were retrospectively analyzed. Pretreatment baseline patient characteristics, treatment efficacy, factors affecting sustained virologic response at 12 weeks (SVR12) after treatment, and adverse reactions were compared between the groups. RESULTS: A total of 327 patients were included in the study, of which 253 were HCV monoinfected, and 74 were HCV/HIV coinfected. There was a statistically significant difference observed in SVR12 when comparing HCV monoinfection and HCV/HIV coinfection (94% and 84%, respectively, p=0.005). However, there were no significant factors identified as a predictor of a reduced response. The most common adverse effect was fatigue (27%). No significant drug interaction was observed between DAA and antiretroviral therapy. None of the patients discontinued the treatment due to adverse events. CONCLUSIONS: In a real-world setting, DAA regimens have lower SVR12 in HCV/HIV coinfection than in HCV monoinfection. Further studies involving a higher number of HCV/HIV coinfected patients are needed to identify real predictors of a reduced response.

Experience with peripheral nerve injury in lower extremities

This study reports the results of 43 operations performed on nerves of lower extremities of 43 patients during a period of 7 years from 1999 - 2005 in Mansoura University Hospital and Mansoura Emergency Hospital. There were 15 patients with isolated sciatic nerve injury, 24 with isolated peroneal nerve injury and 4 with isolated tibial nerve injury. All patients were treated with nerve exploration within 1 hour to 7 months after injury and were followed-up for 6 months to 4 years. There were 22 nerve lesions not in continuity [9 needed suture repair and 13 needed sural nerve graft repair], while 21 nerve lesions were in continuity [16 partial lesions needed neurolysis and 5 complete lesions needed neuroma excision and suture repair]. Analysis of the outcome of surgical treatment was performed with respect to the following parameters: period between the injury and operation, patient age, type of injured nerve, mechanism of injury and type of surgical intervention. Overall significant outcome [>/= 3 Louisiana State University Health Science grade] was obtained in 53.5% [sciatic nerve 46%, peroneal nerve 54% and tibial nerve 75%]. According to the type of intervention and lesion categories; lesions not in continuity had a significant outcome 41% [suture repair 55.5% while graft repair 31%], and lesions in continuity had a significant outcome 67% [lesions underwent neurolysis 75%, while lesions underwent suture repair 40%]. Useful function was achieved in 3 [43%] of 7 patients with grafts less than 6 cm in length and in only 1 [16%] of 6 patients with grafts greater than 6 cm in length. The mean time to recovery in patients who underwent surgery was 18 months [range: 1- 32/ ]. In conclusion, the most favourable outcome was obtained with lesions that result in partial lesion in continuity. Considering the rate of spontaneous recovery of post-injection nerve injuries of the sciatic nerve and early onset of skeletal deformities, a closed nerve injury of the lower limb with no recovery within 3 months should always undergo surgery, even if complete functional outcome is not always guaranteed