Interferon-alpha and ribavarin therapy for hepatitis C in HIV coinfected patients

The following study was presented looking at the safety and efficacy of interferon-alpha and ribavirin therapy in HIV/HCV coinfected individuals.

Initial assessment of the 24 individuals was by daily ribavirin 1200mg alone in order to assess changes in endogenous interferon levels. Following this, individuals received 5 MU of interferon with ribavirin 1200mg daily for 12 weeks. Therapy was then continued up to 48 weeks using 5 MU of interferon 3 times a week with ribavirin 1200mg daily.

Of the 24, 58% (14) were receiving concomitant antiretroviral treatment at the start of the study. HCV- RNA and liver transaminases, HIV – RNA and CD4 count were performed at baseline, 3, 6, 9 and 12 months. A dose reduction was made to 800mg daily ribavirin due to haemolysis in 10 individuals.

At 3 months 6 individuals (25%) had dropped out due to side effects including anaemia, depression, pancreatitis, and intoxication. Of those who continued up to 3 months 9/18 (50%) showed normalisation of elevated liver transaminases and negative HCV-RNA. Median baseline CD4 was 520 cells/ul and fell to 428 cells /_l at 3 months, median baseline HIV-RNA 10,097 copies/ml dropped to 1,274 copies/ml at 3 months. At 12 weeks of treatment 50% have become HCV-RNA negative.

J. K. Rockstroh, G. Klausen, J. Gùlz, S. Dupke, L. Stein, G. Notheis, A. Stoehr, G. R. Pascucci, J.C. Wasmuth and S. Mauss. (P367)

Comment

Concerns about the use of ribavirin in HIV infected individuals has been muted by many due to the potential increase in toxicity resulting in increased rates of anaemia and decrease in CD4; as well as the potential decrease in intracellular activity of ZDV, D4T and 3TC.

However this small study does appear to show that concomitant use of ribavirin and antiretroviral treatment may be safe following the dose reduction to 800 mg. It should be noted that the dropout rate was very high at 25% and no data about HCV genotyping was available.