Clinical

Interferon and cirrhosis tied to liver failure in HIV/HCV coinfection

Last Updated: 2004-09-29 15:37:23 -0400 (Reuters Health)

NEW YORK (Reuters Health) - In patients coinfected with HIV and hepatitis C virus (HCV), and who are also affected by cirrhosis, treatment with interferon (IFN) raises the risk of hepatic decompensation, according to German researchers.

However, this does not necessarily mean that interferon-based therapy should be avoided, Dr. Stefan Mauss and colleagues write in the September 3rd issue of AIDS. Instead, "coinfected patients with histological progression of their chronic hepatitis C should be considered for interferon-based treatment before they develop late stage liver disease."

Dr. Mauss, at the Center for HIV and Hepatogastroenterology in Dusseldorf, and colleagues observed 14 cases of hepatic decompensation among 123 cirrhotic patients enrolled in a clinical trial comparing treatment with peg-IFN alpha-2a or conventional IFN alpha-2a, with or without ribavirin.

Decomposition set in within 24 weeks and was not observed in trial participants who did not have cirrhosis. There was no increase in HCV RNA before decompensation developed.

Multivariate analysis revealed five risk factors associated with hepatic decompensation: increased bilirubin, decreased hemoglobin, increased alkaline phosphatase or decreased platelets, and treatment with didanosine.

Markers of viral replication, histological activity, treatments for hepatitis C, or CD4-positive cell counts were not associated with hepatic decompensation. Treatment with ribavirin or peg-IFN versus conventional IFN did not affect outcomes.

Dr. Mauss's team advises that didanosine be avoided in patients with advanced liver disease. However, these patients should not be excluded from interferon-based therapy, given their lack of options. They should nonetheless be monitored closely.

AIDS 2004;18:F21-F25.