Reuters Health Information (2004-07-28): Peginterferon and ribavirin most effective against HCV in HIV patients
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
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.