Treatment of chronic hepatitis C virus (HCV) infection in human immunodeficiency virus (HIV)–infected patients is a growing concern.
Most data on the virologic efficacy and safety of the combination of peginterferon alfa-2b and ribavirin in coinfected patients come from uncontrolled studies.
Researchers from France undertook a study in order to examine the safety and efficacy of peginterferon alfa-2b plus ribavirin vs standard interferon alfa-2b plus ribavirin in HIV-HCV coinfected patients.
The trial was a multicenter, randomized, parallel-group, open-label trial.
Patients were enrolled from February 2000 to February 2002 and followed up for 72 weeks.
412 HIV-HCV coinfected patients with detectable serum HCV-RNA, abnormal liver histology, a CD4 cell count of at least 200 x 106/L, and stable plasma HIV-RNA.
Participants were treated with ribavirin 400 mg twice a day, orally, plus either peginterferon alfa-2b (1.5 µg/kg subcutaneous injection once a week) or standard interferon alfa-2b (3, 000, 000 units of subcutaneous injection 3 times a week) for 48 weeks.
| Patients with sustained virologic responses in the peginterferon group – 27%|
Standard interferon group - 20%
Researchers observed the sustained virologic response, defined by undetectable serum HCV-RNA at week 72.
More patients had sustained virologic responses in the peginterferon group than in the standard interferon group (27% vs 20%).
This difference between the treatments was found in patients with HCV genotype 1 or 4 infection (17% for peginterferon vs 6% for standard interferon).
However, the difference was not found in patients with HCV genotype 2, 3, or 5 (44% for peginterferon vs 43% for standard interferon).
Together, a decline in HCV-RNA of less than 2 log10 from baseline and detectable serum HCV-RNA at week 12 predicted 99% of treatment failures.
Histologic activity diminished and fibrosis stabilized in virologic responders.
The 2 regimens showed similar tolerability although dose modifications for clinical and biological events were more frequent with peginterferon.
11 cases of pancreatitis or symptomatic hyperlactatemia were observed, all in patients receiving didanosine-containing antiretroviral regimens.
In combination with ribavirin, treatment with peginterferon alfa-2b is more effective than standard interferon alfa-2b for HCV infection in HIV-infected patients.