Hematologic toxicity associated with interferon-based hepatitis C therapy in HIV type 1-coinfected subjects.

TitleHematologic toxicity associated with interferon-based hepatitis C therapy in HIV type 1-coinfected subjects.
Publication TypeJournal Article
Year of Publication2007
AuthorsBehler CM, Vittinghoff E, Lin F, Chung RT, Peters MG, Robbins GK, Volberding PA
JournalClin Infect Dis
Volume44
Issue10
Pagination1375-83
Date Published2007 May 15
ISSN1537-6591
KeywordsAdult, Antiviral Agents, Hematologic Diseases, Hepatitis C, Chronic, HIV Infections, HIV-1, Humans, Interferon-alpha, Maximum Tolerated Dose, Polyethylene Glycols, Recombinant Proteins, Ribavirin
Abstract

BACKGROUND: This study investigates whether dose modifications for adverse hematologic effects or the use of hematopoietic growth factors influenced the outcome of therapy for hepatitis C virus (HCV) infection in patients who were coinfected with HCV and human immunodeficiency virus (HIV) and who were participants in a randomized, controlled trial.

METHODS: Subjects were randomized to receive ribavirin plus interferon-alfa-2a (IFN-alfa-2a) or pegylated IFN-alfa-2a for a total of 48 weeks. Doses were modified for a number of adverse effects (including hematologic toxicity), and hematopoietic growth factors were administered at the discretion of the physician. Associations of dose modifications or initiation of hematopoietic growth factor support with treatment outcomes were determined by standard statistical methods.

RESULTS: One hundred thirty-three subjects were included in this study. Subjects treated with pegylated IFN-alfa-2a were more likely to have had dose modifications (dose reduction or discontinuation) than were those treated with IFN-alfa-2a. By multivariate analysis, treatment with pegylated IFN-alfa-2a is associated with higher sustained virologic and/or histologic response. Dose modifications for nonhematologic toxicity are independently associated with lower sustained virologic and/or histologic responses. Although hematologic toxicity was not directly associated with clinical outcome in this analysis, use of hematopoietic growth factors was associated with an increased sustained virologic and/or histologic response.

CONCLUSIONS: Dose modifications for anti-HCV therapy may adversely affect the outcome of treatment of HCV in individuals who are coinfected with HIV. The use of hematopoietic growth factor support may be associated with an improved clinical response to therapy.

DOI10.1086/515398
Alternate JournalClin. Infect. Dis.
PubMed ID17443478
PubMed Central IDPMC4075655
Grant ListP30 AI27763 / AI / NIAID NIH HHS / United States
U01 AI069502 / AI / NIAID NIH HHS / United States
U01 AI27663 / AI / NIAID NIH HHS / United States