Efficacy of switching to dolutegravir plus rilpivirine, the small-tablet regimen, in patients with dysphagia: two case reports

Abstract Background The advent of well-tolerated and effective anti-retroviral drugs against human immunodeficiency virus-1 (HIV-1) infection has been a major step forward that has achieved long-term survival in recent years. The number of HIV-1 infected patients who experience difficulty in swallowing tablets is expected to increase as the HIV-infected population advances in age or develops comorbidities or treatment sequelae affecting the central nervous system. Case presentation Here, we describe two HIV-1-infected patients who experienced progressive dysphagia leading to inability to swallow the antiretroviral tablets included in the standard regimen. Both patients had a plasma viral load < 40 copies/mL while receiving anti-retroviral therapy with the recommended combination antiretroviral therapy (cART) regimen, but the dysphagia necessitated a switch. By switching to much smaller sized combined regimen of dolutegravir (DTG) plus rilpivirine (RPV) tablets, both of our patients were able to successfully continue treatment and maintain adherence without the need for crushing tablets or preparing an oral suspension. Additionally, switching from the recommended cART regimen to DTG plus RPV successfully maintained viral suppression. At the last available follow-up (12 months after switching to DTG/RPV), HIV-1 viral load remained below the lower limit of quantification. Conclusions An alternative therapeutic option that takes tablet size into consideration could not only contribute to improved patient adherence, but also a reduced care burden for HIV-infected patients with dysphagia. Thus, switching to the “small-tablet regimen” of DTG plus RPV has the potential to improve the survival and well-being of patients with dysphagia

Laparoscopic surgery for ovarian epidermoid cyst with preservation of ovarian function

Ovarian epidermoid cyst, an extremely rare tumor occurring mostly in older females, is lined by mature stratified squamous epithelium and distinguishable from mature teratoma by the absence of skin adnexae and other tissues. In imaging, these tumors resemble solid tumors, necessitating most patients to undergo oophorectomy to verify malignancy. We herein present the case of an ovarian epidermoid cyst in a pregnant woman who underwent laparoscopic cystectomy after delivery with preserved ovarian function. To the best of our knowledge, this is the first case report of an ovarian epidermoid cyst that was detected during pregnancy and treated with laparoscopic cystectomy. Preservation of ovarian function and application of minimally invasive surgery should be strongly considered in young patients with ovarian epidermoid cysts

Mother-to-Child Transmission of Congenital Chagas Disease, Japan

We report a patient with congenital Chagas disease in Japan. This report reemphasizes the role of neglected and emerging tropical diseases in the era of globalization. It also indicates the need for increased vigilance for detecting Chagas disease in non–disease-endemic countries