Risk factors for infection during treatment with peginterferon ALFA and ribavirin for chronic hepatitis C

Robert Roomer 1, Bettina E. Hansen 1,2, Harry L.A. Janssen 1, Robert J. de Knegt 1,*,†

DOI: 10.1002/hep.23842
Copyright © 2010 American Association for the Study of Liver Diseases

Author Information
1 Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
2 Department of Biostatistics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands

Email: Robert J. de Knegt (r.roomer@erasmusmc.nl)

*Correspondence: Robert J. de Knegt, Department Gastrenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Room Ca-415's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands

†Ph: 0031 10 7031617

Publication History
Accepted manuscript online: 29 JUL 2010 12:00AM EST
Manuscript Accepted: 6 JUL 2010
Manuscript Revised: 24 JUN 2010
Manuscript Received: 28 APR 2010

Keywords:
Dose reductions;neutropenia;cirrhosis;HCV;age

Abstract

Neutropenia during treatment with peginterferon alfa and ribavirin for chronic hepatitis C (HCV) is a common cause for dose reductions of peginterferon alfa. These reductions are performed to prevent bacterial and fungal infections, which are common during HCV treatment and attributed to neutropenia. The aims of this study were to investigate the occurrence of infections and their relation to neutropenia and to find potential risk factors for infections during HCV treatment.

In this single center cohort study 2876 visits of 321 patients treated with peginterferon alfa and ribavirin were evaluated for neutropenia, infections, dose reductions and potential risk factors for infection during HCV treatment.

Baseline mean absolute neutrophil count (ANC) was 3420 cells/μL, 16 patients had baseline ANC below 1500 cells/μL. During treatment neutropenia defined as ANC <750 cells/μL was observed in 95 patients (29.7%) and ANC < 375/μL was observed in 16 patients (5%). Ninety-six infections were observed in 70 patients (21.8%). Thirteen infections (13.5%) were defined as severe. Infections were not correlated with neutropenia during treatment. Dose reductions did not lead to a decrease in infection rate. In the multivariate logistic regression analysis age older than 55 (OR 2.06, CI 1.19-3.56, p=0.01) and baseline hyperglycemia (OR 2.17 95% CI 1.15-4.10, p=0.016) were associated with an increased risk of infection during HCV treatment. Cirrhosis and chronic obstructive pulmonary disease (COPD) were no risk factors for infections.

Conclusion:

Bacterial infections during treatment with peginterferon alfa and ribavirin are not associated with neutropenia. Older patients and patients with poorly controlled diabetes mellitus are more at risk to develop infections during HCV treatment. (HEPATOLOGY 2010.)

Source