Reuters Health Information (2004-09-29): Interferon and cirrhosis tied to liver failure in HIV/HCV coinfection
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
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
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.