The incidence, predictors and management of anaemia and its association with virological response in HCV / HIV coinfected persons treated with long‐term pegylated interferon alfa 2a and ribavirin

• Published in: Alimentary pharmacology & therapeutics Vol. 33; no. 11; pp. 1234 - 1244
• Main Authors: Butt, A. A., Umbleja, T., Andersen, J. W., Chung, R. T., Sherman, K. E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.06.2011
• Subjects: Adult; Age; alpha -Interferon; Anemia; Anemia - chemically induced; Antiviral Agents - adverse effects; Drug Therapy, Combination; Erythropoiesis; Female; Hemoglobin; Hepatitis C - complications; Hepatitis C - drug therapy; Hepatitis C virus; HIV Infections - complications; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Interferon; Interferon-alpha - adverse effects; Male; Middle Aged; Multivariate Analysis; Patient Compliance; Polyethylene Glycols - adverse effects; Prospective Studies; Randomized Controlled Trials as Topic; Recombinant Proteins; Ribavirin; Ribavirin - adverse effects; Risk Factors; Time Factors; Treatment Outcome; Zidovudine; Zidovudine - adverse effects
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2011.04648.x

Aliment Pharmacol Ther 2011; 33: 1234–1244 Summary Background  The association of anaemia with outcomes in the HCV/HIV coinfected persons undergoing HCV treatment remains unclear. Aims  To study the incidence, predictors and management of anaemia, and its association with outcomes among persons treated with pegylated interferon and weight‐based ribavirin. Methods  Retrospective analysis of a prospective controlled treatment trial of HCV/HIV coinfection. Results  Among 329 subjects enrolled, 40% developed anaemia during the first 12–18 weeks of treatment (median haemoglobin decrease at week 4: 2.2 g/dL). Among 169 subjects who achieved early virological response and received therapy for 72 weeks, 55% eventually developed anaemia. However, median haemoglobin levels stayed stable after 12–18 weeks of initial therapy. Among these 169 subjects, 45% were prescribed an erythropoiesis stimulating agent (ESA), with 17% receiving it prior to a drop in haemoglobin meeting protocol definition of anaemia. Only 27% completed the study without any ribavirin dose modification. Age >40 years, lower BMI, zidovudine use and lower entry haemoglobin were significant predictors of anaemia in the multi‐covariate model. Among all 329, sustained virological response (SVR) rate was similar in those with or without anaemia (23% vs. 30%; P = 0.17) with no evidence of association between anaemia or ESA use and treatment response. Conclusions  Anaemia is common in HCV/HIV coinfected persons undergoing HCV treatment, and only a minority of them are able to maintain ribavirin dose. Persons with age >40 years, lower baseline haemoglobin and lower baseline BMI should be monitored carefully. Prescription of erythropoiesis stimulating agent is common, but anaemia or erythropoiesis stimulating agent use is not associated with SVR.