Clinical

Interleukin-2 does not improve standard HCV treatment in HIV patients

Last Updated: 2005-03-04 15:11:03 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Although it does not increase toxicity, interleukin-2 (IL-2) does not improve the efficacy of standard treatment for hepatitis C virus (HCV) infection in patients coinfected with HIV, according to a report in the March 1st issue of The Journal of Infectious Diseases.

"There remains a great need to optimize treatment of HCV coinfection," Dr. Marshall J. Glesby from Weill Medical College of Cornell University, New York told Reuters Health. "Unfortunately, combining low dose IL-2 plus standard HCV therapy does not appear to be a promising approach for this patient population."

Dr. Glesby and colleagues investigated the safety and effectiveness of combining IL-2 with pegylated interferon-alpha-2b and ribavirin for HCV coinfection in 23 HIV-positive patients.

More than a quarter of the subjects (6) discontinued therapy before week 24 of the 84 week study, the report indicates, and nearly half (11) discontinued therapy before study completion.

Most patients (18) reported at least a grade 2 symptom during follow-up, the authors report, with the first such adverse effect arising a median 4 weeks into the study.

Only 5 of the patients had HCV-RNA levels below the level of quantification by the end of specific anti-HCV treatment, the researchers note, and only 4 patients had sustained virologic responses. At weeks 72 and 84, 18% of patients had achieved at least a 2-log10 decrease from baseline in HCV-RNA level.

Only a third of the patients had normal ALT levels at week 84, the investigators report, and only 4 subjects (17%) had both biochemical and virologic responses at week 84.

"The fact that there were no major liver toxicities in this study is encouraging," Dr. Glesby said, "since there was concern at the outset that stimulating the immune system through IL-2 use could exacerbate the inflammatory response in the liver and result in liver injury."

"For co-infected patients who are candidates for therapy, treatment with pegylated interferon plus ribavirin remains the gold standard treatment just as it is for HCV monoinfected patients," Dr. Glesby concluded.

"Ongoing research efforts by the AIDS Clinical Trials Group and other research groups will hopefully result in more effective therapy for co-infection in the coming years," Dr. Glesby added.

J Infect Dis 2005; 191:686-693.