Fatal Relapse of Myelodysplastic Syndrome in a Patient with HIV/Hepatitis C Coinfection Treated with Simeprevir/Sofosbuvir.

Registrational studies and observational cohorts clearly suggest sustained virologic response (SVR) rates in HIV-/hepatitis C-coinfected patients are similar to monoinfected patients when utilizing interferon-free regimens, and this can be accomplished with agents that are well tolerated with minimal adverse events. These randomized trials that led to the approval of several of our new direct-acting antiviral agents, however, specifically excluded patients who had significant comorbidities and none to our knowledge accepted patients with a history of cancer. Therefore, the effect of treatment of active hepatitis C in such patients and the effect on preexisting neoplasia are relatively unknown. We prospectively followed a 62-year-old male coinfected with HIV/hepatitis C who had a history of anal squamous cell carcinoma, prostate carcinoma, renal cell carcinoma all clinically cured and a myelodysplastic syndrome that was in remission. The patient achieved an SVR of hepatitis C with simeprevir/sofosbuvir without ribavirin and died shortly thereafter of a fatal relapse of his previously clinically controlled myelodysplastic syndrome.

Lopinavir/ritonavir dosage form affects quality of life during monotherapy in HIV-positive adults.

This was a single-center, open-label study of lopinavir/ritonavir (LPV/r) single-agent therapy in antiretroviral-naive, HIV-infected participants initiating therapy with twice-daily soft-gelatin capsules (SGC) and switched to tablets after ≥4 weeks. The objective was to evaluate quality of life and tolerability of the 2 formulations. Participants quality of life, depression, and tolerability were measured using the Medical Outcomes Study-HIV (MOS-HIV), Modified Global Condition Improvement (GCI), and Center for Epidemiologic Studies-Depression (CES-D), prior to and 4 weeks following switch. MOS-HIV showed significant improvements in general health perception (+6 (16), mean (SD); P = .047) and role functioning (+8 (19), mean (SD); P = .023) post-switch. GCI showed significant improvement in ease of taking medications with tablets (56.7% vs 83.3%; P = .021). No change was observed in CES-D. Tolerability improved in 47%. Reported diarrhea (grade 2) was higher during SGC (33.3% vs3.3%; P = .004). Quality-of-life measures, tolerability, and diarrhea improved with the LPV/r tablet formulation compared to SGC in HIV-positive patients not receiving other antiretroviral therapy (ART).