Sofosbuvir and simeprevir combination therapy in the setting of liver transplantation and hemodialysis.

We report safety, tolerability, and 12-week sustained virologic response with half-standard dose sofosbuvir and standard-dose simeprevir combination therapy in a hepatitis C virus genotype 1a-infected liver transplant recipient on hemodialysis - uncharted territory for sofosbuvir-based therapy. The patient was a non-responder to prior treatment with pegylated interferon plus ribavirin. Sofosbuvir efficacy was maintained despite pill-splitting and administration of half-standard dose, 200 mg per day. No drug-drug interactions were noted with tacrolimus-based immunosuppression. Laboratory tests remained stable or improved during therapy. Our observation, if reproduced in a larger study, may lead to significant improvement in clinical outcomes and cost savings in this patient population.

Assessment of synthetic peptides of severe acute respiratory syndrome coronavirus recognized by long-lasting immunity.

In order to determine highly immunogenic severe acute respiratory syndrome coronavirus (SARS-CoV) epitope peptides capable of inducing long-lasting immunity, we first screened immunoglobulin-G (IgG) antibodies reactive to 197 different overlapping 15-mers from the SARS-CoV proteins in the sera of three infected patients. Forty-two peptides among them were reactive to the sera from all three patients. Consequently, we tested for the reactivity of these 42 peptides to patients' sera (n = 45) at 6-month post-infection. The significantly higher levels of IgG antibodies specific to three (S791, M207 and N161) of 42 peptides were detectable in the post-infection sera from 23 (51%), 27 (60%) and 19 (42%) of 45 patients, respectively. These three peptides, recognized by their long-lasting immunity, may provide a better understanding of the immunogenicity of SARS-CoV.

The pharmacokinetics of artemisinin after administration of two different suppositories to healthy Vietnamese subjects.

Eight healthy Vietnamese male subjects received 400 mg artemisinin formulated into fatty suppositories (FS), and six different subjects received 500 mg of artemisinin formulated in polyethylene glycol suppositories (PEGS). Plasma concentrations were measured by high-performance liquid chromatography with electrochemical detection; concentration versus time curves were analyzed with nonparametric methods. No statistically significant differences were found between the two formulations. The maximum concentration (Cmax) was 100 +/- 102 microg/L (mean +/- SD, range = 24-330) microg/L (FS), the pharmacokinetic lag time (Tlag) was 1.3 +/- 1.0 hr (range = 0-3) (FS), and the time of the maximum concentration (Tmax) was 7.1 +/- 2.1 hr (range = 3-10) hr (FS). Because artemisinin is not available for intravenous dosage, absolute bioavailability cannot be assessed. However, compared with a previous study on oral artemisinin in healthy Vietnamese subjects, bioavailability relative to oral administration was estimated to be approximately 30%. We conclude that therapeutic blood concentrations of artemisinin can be reached after rectal dosage. The dose after rectal administration should probably be higher than after oral administration; doubling or tripling the oral dose might be necessary, which would imply a rectal dose of at least 20 mg/kg of body weight given twice a day.

Declining concentrations of dihydroartemisinin in plasma during 5-day oral treatment with artesunate for Falciparum malaria.

Six patients with uncomplicated falciparum malaria received artesunate for 5 days. Plasma concentrations of artesunate and dihydroartemisinin were determined by high-performance liquid chromatography with electrochemical detection. The concentrations of dihydroartemisinin in plasma 2 h after a dose showed a time-dependent decline. Concentrations of artesunate in plasma especially after the last dose, were very low. Despite this, all patients responded with a fast recovery.

Paragonimiasis in Sin Ho District, Lai Chau Province, Viet Nam.

Forty-four cases of pulmonary paragonimiasis, two also with evidence of cerebral infection, were found in Sin Ho District in Northern Viet Nam. There were 30 males and 14 females, 2-30 years of age. The diagnosis was made by sputum examination. Pet dogs and wild dogs in the area were also found infected and the people often eat roasted crabs.

Acute viral hepatitis in Hanoi, Viet Nam.

A study of acute hepatitis was conducted in Hanoi, Viet Nam, from January 1993 to February 1995; 188 sera from clinical hepatitis cases were screened by enzyme-linked immunosorbent assay for immunoglobulin (Ig) M anti-hepatitis A virus (HAV), IgM anti-hepatitis B core antigen (HBc), IgG anti-hepatitis C virus (HCV), IgG anti-hepatitis E virus (HEV) and IgM anti-HEV. Additionally, 187 sera from control subjects, matched by age, sex and month of admission, with no recent history of hepatitis, were tested for comparative purposes. There was serological evidence of recent HAV (29%) and hepatitis B virus (24%) infection in 53% of cases (2 mixed infections), compared with 2% of controls. HCV infections were detected in 10% of cases (with no IgM anti-HAV or IgM anti-HBc) and in 1% of control sera. There was no significant difference in the proportion of IgG anti-HEV positive sera between cases (in the absence of IgM anti-HAV or IgM anti-HBc) (21%) and controls (14%); 3% of all case sera were IgM anti-HEV positive. Younger cases (< 20 years) were more likely to have recent HAV infections (41%) than those aged > or = 20 years (21%) (P < 0.01). In contrast, a higher percentage of adult cases had IgM anti-HBc, IgG anti-HCV and IgG anti-HEV (in the absence of recent HAV or HBV infection) than did children. No seasonal trend in hepatitis admissions was detected, nor an association between water-borne infections (HAV and HEV) and the warmer months. Hepatitis patients lived throughout Hanoi and surrounding areas, with no identifiable geographical clustering, regardless of serological marker.