HIV/Hepatitis C virus-coinfected virologic responders to pegylated interferon and ribavirin therapy more frequently incur interferon-related adverse events than nonresponders do

Abstract

Background: This study aimed to assess the relationship between interferon (IFN)-related adverse effects and Hepatitis C virus (HCV) virologic response in HIV/HCV-coinfected individuals treated with pegylated interferon and ribavirin.

Methods: We conducted 2 prospective, open-label trials treating HIV/HCV-coinfected individuals with pegylated interferon alpha-2b or alpha-2a and ribavirin for 48 weeks. Safety laboratories, HCV RNA, psychiatric, and ophthalmologic evaluations were performed at baseline and monthly until week 72.

Results: Responders were defined as those with HCV RNA decline of > or = 2-log drop from baseline and nonresponders were those who did not. Remarkably, of the 27 patients (50%) who developed psychiatric toxicities, 26 patients were responders, although only 1 of 14 virologic nonresponders experienced psychiatric toxicity. Other adverse effects, such as anemia and ophthalmologic toxicities, were also more frequent in responders compared with nonresponders. Decline in CD4 T-cell counts strongly correlated with HCV viral decline.

Conclusions: Our study demonstrates coupling of antiviral effect and occurrence of adverse events in HIV/HCV-coinfected patients. These patients with IFN-related adverse effects need a multidisciplinary treatment approach, hence, they are more likely to achieve sustained virologic response. Future studies are needed to evaluate the factors that predict the development of IFN-alpha-dependent adverse events before therapy.

Conflict of interest statement

Conflict of Interest Statement

None of the authors have any conflicts of interest to report.

Figures

Figure 1

Relationship between log of HCV viral load and log of CD4 count for each patient for non-responders (top panel) and responders (bottom panel). Each line summarizes the relationship between log HCV viral load and log CD4 count for one patient, and was estimated using ordinary regression. The great majority of patients’ lines had positive (blue) slopes, indicating that log viral load and CD4 counts tracked together. Only a few patients had negative (red) slopes.

Figure 2

Incidence of common adverse events in both responders and non-responders. Significantly higher percent of responders experienced a psychiatric adverse event than non-responders (p=0.009) (Figure 2A). Most responders and non-responders experienced neutropenia (Figure 2B) and anemia (Figure 2C), and both these events were not statistically significant (p>0.05 each). There were no significant differences in the incidence of ophthalmologic toxicities between the two groups (p>0.05) (Figure 2D), however the serious dose-limiting ophthalmic toxicities all occurred in subjects who were responding to IFN-α treatment (as described in the Results).