The effects of dronabinol on appetite and weight were evaluated in 139 patients with AIDS-related anorexia and > or = 2.3 kg weight loss in a multi-institutional study. Patients were randomized to receive 2.5 mg dronabinol twice daily or placebo. Patients rated appetite, mood, and nausea by using a 100-mm visual analogue scale 3 days weekly. Efficacy was evaluable in 88 patients. Dronabinol was associated with increased appetite above baseline (38% vs 8% for placebo, P = 0.015), improvement in mood (10% vs -2%, P = 0.06), and decreased nausea (20% vs 7%; P = 0.05). Weight was stable in dronabinol patients, while placebo recipients had a mean loss of 0.4 kg (P = 0.14). Of the dronabinol patients, 22% gained > or = 2 kg, compared with 10.5% of placebo recipients (P = 0.11). Side effects were mostly mild to moderate in severity (euphoria, dizziness, thinking abnormalities); there was no difference in discontinued therapy between dronabinol (8.3%) and placebo (4.5%) recipients. Dronabinol was found to be safe and effective for anorexia associated with weight loss in patients with AIDS.

We studied the effects of long-term (12 months) dronabinol in 94 late-stage acquired immunodeficiency syndrome (AIDS) patients (mean CD4 count of 45/mm3) who previously participated in a 6-week study (placebo versus dronabinol). All patients received dronabinol orally-2.5 mg twice daily (90%) or 2.5 mg once daily (10%). Appetite was measured using a visual analogue scale for hunger (VASH). Dronabinol was associated with consistent improvement in mean appetite. Patients previously treated with dronabinol continued to show improvement in VASH (percent change from baseline of 6-week trial: 48.6-76.1% at each month), whereas those previously treated with placebo exhibited substantial improvement in mean appetite, particularly during the initial 4 months of treatment (48.5-69.9%). Thereafter, dronabinol was associated with a VASH change at least twice baseline. Patients tended toward stable body weight for at least 7 months. Adverse events were primarily related to known central nervous system effects of dronabinol. These data support long-term, safe use of dronabinol for anorexia associated with weight loss in patients with AIDS.

Incorporating telaprevir into treatment of acute genotype 1 HCV in HIV-infected men halved the treatment duration and increased the SVR rate. Larger studies should be done to confirm these findings. Clinicians should be alert to detect acute HCV infection of HIV-infected men to take advantage of this effective therapy and decrease further transmission in this epidemic.

2. Domingo P, Ris J, Lopez-Contreras J, Sancho F, Nolla J. Appendicitis disease; normal radiographs of the lungs; and cultures of the blood, due to Mycobacterium avium complex in a patient with AIDS [letter].urine, and gastric aspirate that were negative for mycobacteria. Amphotericin B Lipid Complex Therapy in an AIDS Patient with Rhodotorula rubra FungemiaRhodotorula species, yeasts that belong to the family Cryptococcaceae, characteristically produce a coral-red pigment, hence the term, ''red yeast'' (figure 1). Rhodotorula species are found in soil, water, plant materials, and other environmental sources. They have been isolated from the skin, nails, conjunctiva, and the respiratory, gastrointestinal, and urinary tracts, and they are generally considered commensals or contaminants [1, 2]. However, in immunocompromised individuals, infections due to typically nonpathogenic commensal organisms such as Rhodotorula species may occur and can be lifethreatening. Patients with solid tumors, lymphoproliferative diseases, AIDS, chronic renal failure, and diabetes mellitus are at greatest risk. Reports of infections due to Rhodotorula species include septicemia, endocarditis, meningitis, ventriculitis, and peritonitis [3, 4]. Other Figure 1. Culture of blood, obtained from a 50-year-old patient with than immunologic compromise, the common risk factor associated AIDS, on Sabouraud-dextrose agar that yielded Rhodotorula rubra. with these infections in most patients is the use of indwelling vascular catheters [3, 5,6].The treatment of catheter-related infections due to Rhodotorula gal therapy either alone or together are unclear. We report a case species is controversial. The roles of catheter removal and antifunof Rhodotorula fungemia in a patient with AIDS who required removal of his Hickman catheter and treatment with amphotericin B lipid complex to sterilize his blood.Financial support: The Liposome Company, Princeton, New Jersey.A 50-year-old homosexual man was diagnosed with AIDS in 1992. drome, esophageal candidiasis, and chronic renal insufficiency sec-

BackgroundTreatment of HIV-infected men during early hepatitis C virus (HCV) infection with interferon results in a higher cure rate with a shorter duration of treatment than during chronic HCV infection. We recently demonstrated that this phenomenon applied to interferon-free treatment as well, curing most participants with short-course sofosbuvir and ribavirin. Due to the significantly higher potency of the ledipasvir/sofosbuvir (LDV/SOF) combination, we hypothesized that we would be more successful in curing early HCV infections using a shorter course of LDV/SOF than that used for treating chronic HCV infections.MethodsWe performed a prospective, open-label, consecutive case series study of 8 weeks of LDV/SOF in HIV-infected men with early genotype 1 HCV infection. The primary end point was aviremia at least 12 weeks after completion of treatment.ResultsWe treated 25 HIV-infected men with early sexually acquired HCV infection with 8 weeks of LDV/SOF, and all 25 (100%) were cured. Twelve (48%) reported sexualized drug use with methamphetamine.ConclusionsEight weeks of LDV/SOF cured all 25 HIV-infected men with early HCV infection, including those who were actively using drugs. Based on these results, we recommend treatment of newly HCV-infected men during early infection, regardless of drug use, to both take advantage of this 8-week treatment and to decrease further HCV transmission among this group of men.