Direct-acting antivirals (DAAs) can improve outcomes for chronic hepatitis C (CHC) patients. However, they are vulnerable to drug- drug interactions (DDIs), especially patients with other medical conditions. Utilizing data from the Medical Data Vision database, we examined the prevalence of comorbidities and potential DDIs between comedications and DAA regimens in CHC patients in Japan. Of 173,796 patients identified (mean age = 69.0 years), 37.2% had stage F3-4 fibrosis and 11.3% had received ≥1 DAA regimen. Most patients (84.4%) had ≥1 comorbidity, with the mean number of comorbidities per patient increasing with age. Potential contraindicated DDIs in DAA-untreated patients were least likely to occur with elbasvir (EBR) +grazoprevir (GZR) (1.6%) and sofosbuvir (SOF)/velpatasvir (VEL) (1.7%) and most likely with paritaprevir/ombitasvir/ritonavir (15.9%) and daclatasvir+asunaprevir (12.7%). Potential DDIs remained consistently low across age groups for EBR+GZR and SOF/VEL. It is necessary to consider potential DDIs when determining a suitable DAA regimen.

A woman in her 70s, had been undergoing treatment for cirrhosis due to nonalcoholic steatohepatitis for the past 7years. She experienced repeated bleeding from esophageal varices and gastric antral vascular ectasia, and her pancytopenia progressed. Consequently, a laparoscopic splenectomy was performed in the previous year. A 2.7-cm hepatocellular carcinoma was detected in liver segment S4 by abdominal magnetic resonance imaging (MRI) 5 months ago, and stereotactic body radiation therapy was administered. During follow-up, abdominal MRI revealed enlarged abdominal lymph nodes. Endoscopic ultrasound-guided fine needle aspiration confirmed the diagnosis of hepatocellular carcinoma lymph node metastasis. Durvalumab and tremelimumab were administered. After two courses, the enlarged lymph nodes disappeared on abdominal MRI and tumor markers normalized. Herein, we present a rare case of chemotherapy efficacy with durvalumab and tremelimumab for unresectable hepatocellular carcinoma after splenectomy.

A 60-year-old woman was diagnosed with adult-onset Still's disease after presenting with high-grade fever, arthralgia, and sore throat for two weeks in addition to salmon-pink rash predominant in the lower extremities, splenomegaly, liver dysfunction, and high serum ferritin and C-reactive protein levels. Treatment with steroids was initiated, and two doses of intravenous tocilizumab were administered on postadmission day 20. Following improvement in liver function and inflammatory marker levels, the patient was discharged on postadmission day 40 while continuing treatment with prednisolone at 30 mg/day. However, at two-week outpatient follow-up evaluation, she was readmitted due to recurring liver dysfunction (aspartate transaminase, 990 Ul/L; alanine transaminase, 2284 IU/L). Relapse of Still's disease was ruled out due to the absence of fever, skin rash, and arthralgia and the lack of increase in serum inflammatory marker levels. Histopathologic evaluation of the liver biopsy specimens revealed few nuclear mitotic figures in hepatocytes and <1% of cells positive for Ki-67 with immunostaining, suggesting liver damage caused by apoptosis and leading to the diagnosis of tocilizumab-induced liver injury. Indeed, gradual improvement of liver function was observed after tocilizumab discontinuation. The present case illustrates that tocilizumab may lead to severe liver damage and that regular monitoring of liver function is necessary in tocilizumab-treated patients.

The prefectural dental associations (PDAs) in Hiroshima, Chiba, and Shiga initiated a hepatitis awareness project similar to the one led by the Aichi Dental Association (ADA). These seminars, sponsored by PDAs, provide dentists with information about hepatitis and encourage certification as hepatitis medical care coordinators (hepatitis coordinators). In fiscal year (FY) 2023, 21.4% (301/1405) of hepatitis coordinators in Aichi were dentists. The ratios of dentists among hepatitis coordinators certified in FY2023 were 25.2% (70/278), 7.7% (19/248), 10.4% (22/211), and 40.2% (37/92) in Aichi, Hiroshima, Chiba, and Shiga, respectively. Training of dentists progressed across 5 prefectures in FY2020, 8 in FY2021, and 13 in FY2022. To determine the project's effectiveness, the ADA plans to conduct survey among its members.