The incidence, predictors and management of anaemia and its association with virological response in HCV / HIV coinfected persons treated with long-term pegylated interferon alfa 2a and ribavirin.

TitleThe incidence, predictors and management of anaemia and its association with virological response in HCV / HIV coinfected persons treated with long-term pegylated interferon alfa 2a and ribavirin.
Publication TypeJournal Article
Year of Publication2011
AuthorsButt AA, Umbleja T, Andersen JW, Chung RT, Sherman KE
Corporate AuthorsActg A5178 Study Team
JournalAliment Pharmacol Ther
Volume33
Issue11
Pagination1234-44
Date Published2011 Jun
ISSN1365-2036
KeywordsAdult, Anemia, Antiviral Agents, Drug Therapy, Combination, Female, Hepatitis C, HIV Infections, Humans, Interferon-alpha, Male, Middle Aged, Multivariate Analysis, Patient Compliance, Polyethylene Glycols, Prospective Studies, Randomized Controlled Trials as Topic, Recombinant Proteins, Ribavirin, Risk Factors, Time Factors, Treatment Outcome, Zidovudine
Abstract

BACKGROUND: The association of anaemia with outcomes in the HCV/HIV coinfected persons undergoing HCV treatment remains unclear.

AIMS: To study the incidence, predictors and management of anaemia, and its association with outcomes among persons treated with pegylated interferon and weight-based ribavirin.

METHODS: Retrospective analysis of a prospective controlled treatment trial of HCV/HIV coinfection.

RESULTS: Among 329 subjects enrolled, 40% developed anaemia during the first 12-18 weeks of treatment (median haemoglobin decrease at week 4: 2.2 g/dL). Among 169 subjects who achieved early virological response and received therapy for 72 weeks, 55% eventually developed anaemia. However, median haemoglobin levels stayed stable after 12-18 weeks of initial therapy. Among these 169 subjects, 45% were prescribed an erythropoiesis stimulating agent (ESA), with 17% receiving it prior to a drop in haemoglobin meeting protocol definition of anaemia. Only 27% completed the study without any ribavirin dose modification. Age >40 years, lower BMI, zidovudine use and lower entry haemoglobin were significant predictors of anaemia in the multi-covariate model. Among all 329, sustained virological response (SVR) rate was similar in those with or without anaemia (23% vs. 30%; P=0.17) with no evidence of association between anaemia or ESA use and treatment response.

CONCLUSIONS: Anaemia is common in HCV/HIV coinfected persons undergoing HCV treatment, and only a minority of them are able to maintain ribavirin dose. Persons with age >40 years, lower baseline haemoglobin and lower baseline BMI should be monitored carefully. Prescription of erythropoiesis stimulating agent is common, but anaemia or erythropoiesis stimulating agent use is not associated with SVR.

DOI10.1111/j.1365-2036.2011.04648.x
Alternate JournalAliment. Pharmacol. Ther.
PubMed ID21535051
PubMed Central IDPMC3184244
Grant ListK24 DK078772 / DK / NIDDK NIH HHS / United States
U01 AI068636 / AI / NIAID NIH HHS / United States
U01 AI068636-01 / AI / NIAID NIH HHS / United States
U01AI068636 / AI / NIAID NIH HHS / United States