Clinical

Peginterferon and ribavirin most effective against HCV in HIV patients

Last Updated: 2004-07-28 17:00:10 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Peginterferon alfa-2a plus ribavirin is more effective than interferon plus ribavirin or peginterferon monotherapy at controlling chronic hepatitis C virus (HCV) infection in patients also infected with HIV, according to the findings of two studies reported in the July 29th issue of The New England Journal of Medicine.

In the AIDS Pegasys Ribavirin International Coinfection Trial (APRICOT), Dr. Francesca J. Torriani, from the University of California at San Diego, and colleagues assessed the outcomes of 868 patients who were treated with peginterferon plus ribavirin, peginterferon plus placebo, or interferon alfa-2a plus ribavirin. The treatment phase lasted 48 weeks and the subjects were followed for an additional 24 weeks.

The overall rate of sustained virologic response (SVR) in the peginterferon/ribavirin group was 40%, significantly higher than the 12% and 20% rates seen in the interferon/ribavirin and peginterferon monotherapy groups, respectively (p < 0.001 for both).

SVR rates were lower with HCV genotype 1 infections than with genotype 2 infections. With both, the peginterferon/ribavirin combination provided the highest SVR rates.

Neutropenia and thrombocytopenia occurred more often with peginterferon-containing regimens, whereas anemia was more prevalent when ribavirin was given.

In the second study, Dr. Raymond T. Chung, from Massachusetts General Hospital in Boston, and colleagues evaluated the SVR of 133 HCV/HIV-coinfected patients who were randomized to receive ribavirin in combination with peginterferon or interferon for several weeks.

As in APRICOT, peginterferon/ribavirin was associated with a significantly higher SVR rate than interferon/ribavirin: 27% versus 12%. Moreover, the researchers also found that SVR rates were lower with HCV genotype 1 infections. Liver biopsy revealed a histologic response in 35% of subjects lacking a virologic response.

There was no evidence that either treatment regimen adversely affected control of HIV disease, the researchers note.

The findings from these studies "show that a SVR can be achieved with peginterferon and ribavirin therapy in a substantial proportion of coinfected patients," Dr. Jean-Michel Pawlotsky, from Henri Mondor Hospital in Creteil, France, notes in a related editorial. "These results together with the poor prognosis for HIV-positive patients with HCV infection, justify broad use of antiviral therapy in the treatment of coinfected patients."

N Engl J Med 2004;351:422-423,438-459.