Incidence of anaemia and impact on sustained virological response in HIV/HCV-coinfected patients tre

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J Viral Hepat. 2007 Dec 21 [Epub ahead of print]

Incidence of anaemia and impact on sustained virological response in

HIV/HCV-coinfected patients treated with pegylated interferon plus ribavirin.

Núñez M, Ocampo A, Aguirrebengoa K, Cervantes M, Pascual A, Echeverria S, Asensi

V, Barreiro P, -Samaniego J, Soriano V; on behalf of the PRESCO Team.

Hospital III, Madrid, Spain.

Ribavirin (RBV) exposure is important for maximizing the response to chronic

hepatitis C virus (HCV) therapy. However, RBV-associated haemolytic anaemia may

force dose reductions or even treatment discontinuation. The use of zidovudine

might further increases the risk of anaemia in HCV/HIV-coinfected patients. The

predictors of anaemia were examined in PRESCO, a large trial conducted in

HIV/HCV-coinfected patients treated with pegylated interferon alpha-2a 180

mug/week plus RBV 1000-1200 mg/day. Measurements included maximal decrease in

haemoglobin (Hb) throughout treatment, drops in Hb to < 0.0001] and greater Hb

drops during the first 4 weeks of therapy [RR: 4.74 (95% CI 2.95-7.60); P <

0.0001] were independent predictors of moderate anaemia at any time point in the

multivariate analysis. Mean drops in Hb from baseline to week 4 were

significantly greater in patients receiving zidovudine compared with other drugs

(-3.09 vs-2.3 g/dL; P < 0.001). Lower baseline Hb [RR: 0.33 (95% CI 0.11-0.95);

P = 0.04] and maximal Hb drops during treatment [RR: 2.48 (95% CI 1.33-4.59); P

= 0.004] predicted treatment discontinuation because of anaemia. However,

maximal Hb drops, development of moderate-severe anaemia and RBV dose reductions

were comparable among patients who achieved SVR and those who did not. Lower

baseline Hb predicts maximal drops in Hb and development of anaemia in

HIV/HCV-coinfected patients treated with pegylated interferon plus RBV. The use

of zidovudine is associated with greater Hb declines at week 4. However, severe

anaemia is relatively infrequent and seems not to have much impact on SVR. Given

the availability of alternative antiretroviral drugs, it is advised to avoid

zidovudine while receiving anti-HCV treatment.

PMID: 18179454 [PubMed - as supplied by publisher]

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