Clinical

Ribavirin-related anemia may limit response in HIV/HCV-infected patients

Last Updated: 2004-04-22 16:40:51 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Combination therapy with interferon-alpha-2b and ribavirin appears to be relatively safe for HIV/hepatitis C virus (HCV)-coinfected patients, but the sustained viral response (SVR) rate remains low, according to a report published in the April issue of Hepatology.

In studies of patients infected with HCV alone, adding ribavirin to interferon-alpha-2b has been shown to improve the SVR rate, Dr. Jeffrey J. Smith, from the American Foundation for AIDS Research (amFAR) in New York, and colleagues note. The safety and efficacy of this drug combination in HIV/HCV-coinfected patients has been less clear.

The present study involved 107 coinfected patients who were randomized to receive 48 weeks of interferon therapy combined with a full or 16-week delayed course of ribavirin.

At posttreatment week 24, the SVR rate in the full ribavirin group was 11.3%, higher, but not significantly different from the rate in the delayed ribavirin group, 5.6%, the authors point out. Among patients in the full ribavirin group, those with HCV genotype 1 had an SVR of just 2.5%, while those with other genotypes had a rate of 41.7% (p = 0.002).

The authors believe that a higher SVR rate could have been achieved had there not been frequent treatment discontinuations and anemia-related reductions in the ribavirin dose. Fifty-five patients stopped treatment early, usually due to adverse effects, and 21 patients had anemia-related ribavirin dose reductions. In both treatment groups, use of zidovudine was predictive of such dose reductions.

There was no evidence that treatment with ribavirin and interferon-alpha-2b impaired HIV control, the investigator note. In fact, in a minority of patients, this treatment was associated with an increase in the CD4+ count and with a drop in the viral load to undetectable levels.

"Although some patients and clinicians may be disappointed by the relatively low SVR rate..., they must recognize that this study represents an important first step on a steep learning curve to define the standard of care for the management of hepatitis C in the HIV-infected person," Dr. Mark S. Sulkowski, from Johns Hopkins University in Baltimore, notes in a related editorial.

"Data from this and future randomized, controlled trials will provide the critical evidence needed to more effectively confront the growing problem of HCV-related liver disease in HIV-infected persons," he adds.

Hepatology 2004;39:906-908,989-998.