Pegylated IFN-α2b plus ribavirin as therapy for chronic hepatitis C in HIV-infected patients

Abstract

Treatment with peg-IFN and ribavirin is relatively well-tolerated in HIV/HCV-co-infected patients, although new side-effects, including pancreatitis and severe weight loss, may result from the interaction of ribavirin with antiretroviral drugs. Overall, therapy provides cure to one third of patients, a rate significantly lower than that seen in HCV-monoinfected individuals. Given that relapses are common, extended periods of therapy should be investigated.

Efficacy and Safety of Pegylated Interferon-α2b Plus Ribavirin for the Treatment of Chronic Hepatitis C in HIV-Infected Patients

“…However, psychiatric disorders are of special concern, because of their potential severity and the high rate of treatment discontinuation. No deaths, life-threatening complications such as lactic acidosis and pancreatitis, [6][7][8]16 or new or unexpected adverse events were seen. In addition, a high rate of liver decompensation in the course of treatment was reported in coinfected patients with histologically proven cirrhosis.…”

“…15 In contrast, data from the RIBAVIC study 9 with peg-IFN alfa-2b plus ribavirin obtained an SVR rate of 27%, a figure closer to ours and to those reported previously in an open-label study. 7 In addition to differences in patients' baseline characteristics, methodology, therapeutic regimens, and study settings, premature discontinuation rates make a significant contribution to the huge discrepancies in efficacy rates. Thirty-nine percent of patients treated with peg-IFN and ribavirin discontinued treatment in the RIBAVIC study, as compared to 25% in the APRICOT study.…”

“…4 In addition to the well-recognized adverse events, the increased risk of severe lactic acidosis, pancreatitis, and hepatic decompensation in the course of treatment with concomitant antiretroviral therapy is of special concern. [6][7][8] The real extent of this problem is unknown, but certain risk factors have been identified, such as treatment with didanosine. 8,9 In mid-2001, the encouraging results obtained in non-HIV patients 10,11 prompted us to implement treatment of CHC in HIV-coinfected patients with a combination of peg-INF and ribavirin in our hospital and associated centers.…”

Evaluation of the therapeutic response of hepatitis C in coinfected patients (HIV/HCV): a study of cases from a hospital for chronic liver diseases in the Eastern Brazilian Amazon

“…The biochemical response in HCV-HIV co-infected patients is not a good marker of SVR. In the, APRICOT (Aids Pegasys Ribavirin International Coinfection Trial), RIBAVIC, LAGUNO and PRESCO studies studies [16][17][18][19] , patients were using the HAART scheme in more than 70% of the cases, the mean CD4+ lymphocyte counts were above 500 cells/mm 3 and the ALT levels were normal in only 16% of cases in the RIBAVIC study. In the RIBAVIC (Ribavirin Study Team (France) and PRESCO studies, the stages of fibrosis were measured by the METAVIR classification (F3/F4) and were reported in 28 and 39% of cases, respectively.…”

Hepatitis por virus C y drogodependencias

“…No obstante hay que tener en cuenta que este tratamiento presenta una gran variedad de efectos adversos y contraindicaciones (algunas de ellas afectan muy directamente a la población drogodependiente). Por otra parte, en la coinfección VHC/VIH no está tan claro si el porcentaje de éxito terapéutico alcanza los mismos niveles que en la población no coinfectada 30 , sobre todo en los pacientes inmunodeprimidos, y además se añaden a los efectos adversos, los posibles problemas de las interacciones con la terapia antirretroviral que en ocasiones puede llegar a producir efectos graves, como la acidosis lác-tica, con desenlace fatal. Por consiguiente, es de gran importancia valorar específicamente a cada paciente afecto de hepatitis crónica C, a fin de tomar decisiones sobre la conveniencia o no de realizar tratamiento específico para su hepatitis y cuándo es el mejor momento, sopesando por una parte el curso evolutivo de su propia infección, los riesgos inherentes al tratamiento y la posibilidad de la falta de adherencia a un tratamiento prolongado con bastantes efectos adversos.…”