Peginterferon plus ribavirin for chronic hepatitis C in patients with human immunodeficiency virus

Am J Gastroenterol. 2009 Sep;104(9):2335-41; quiz 2342. doi: 10.1038/ajg.2009.311. Epub 2009 Jun 9.

Abstract

Objectives: The aim of this study was to assess the effects of peginterferon plus ribavirin for chronic hepatitis C in patients with human immunodeficiency virus (HIV).

Methods: Trials were identified through manual and electronic searches. Randomized trials comparing peginterferon plus ribavirin with other antiviral treatments for patients with chronic hepatitis C and HIV were included. The primary outcome measure was virological response at the end of treatment and after > or =6 months (sustained). Intention-to-treat meta-analyses including data on all patients who were randomized were carried out.

Results: Seven randomized trials were eligible for inclusion. The patients included had chronic hepatitis C and stable HIV and were not previously treated with interferon or ribavirin (treatment naive). The mean dosages were 180 or 1.5 microg/kg once weekly for peginterferon and 800 mg daily for ribavirin. The treatment duration ranged from 24 to 48 weeks. Peginterferon plus ribavirin increased the proportion of patients with an end-of-treatment or sustained virological response compared with interferon plus ribavirin or peginterferon alone. In subgroup analyses of trials comparing peginterferon plus ribavirin with interferon plus ribavirin, the proportion with a sustained virological response was 26% (109 of 423) for patients with genotype 1 or 4 and 57% (130 of 230) for genotype 2 or 3. Several adverse events occurred, including fatal lactic acidosis and liver failure, but there were no significant differences in mortality rates between treatment groups.

Conclusions: Peginterferon plus ribavirin may be considered for treatment-naive patients with HIV and chronic hepatitis C. Adverse events should be monitored carefully.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adult
  • Antiviral Agents / administration & dosage*
  • Drug Therapy, Combination
  • Female
  • HIV Infections / complications*
  • Hepatitis C, Chronic / complications
  • Hepatitis C, Chronic / drug therapy*
  • Humans
  • Interferon alpha-2
  • Interferon-alpha
  • Male
  • Middle Aged
  • Polyethylene Glycols
  • Recombinant Proteins
  • Ribavirin / administration & dosage*

Substances

  • Antiviral Agents
  • Interferon alpha-2
  • Interferon-alpha
  • Recombinant Proteins
  • Polyethylene Glycols
  • Ribavirin
  • peginterferon alfa-2b
  • peginterferon alfa-2a