July 23, 2013

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Serrano-Villar S. Clin Infect Dis. 2013;57:458-464.

July 19, 2013

Patients with HIV and HCV who experience neutropenia during therapy with pegylated interferon and ribavirin are no more likely to develop infection than those who do not, according to recent results.

In a prospective cohort study, researchers evaluated 418 patients coinfected with HIV and chronic HCV who received treatment with peginterferon and ribavirin between 2000 and 2012. All patients either received 180 mcg weekly peginterferon alfa-2a or 1.5 mcg/kg peginterferon alfa-2b subcutaneously, along with weight-adjusted oral ribavirin. Infections requiring treatment discontinuation or hospitalization, or resulting in death, were classified as serious.

Infection occurred in 149 cases across 123 patients, for a rate of 3.8 infections per 100 person-weeks of treatment. Forty-seven percent of these were minor and involved the upper respiratory tract. Other common infections included skin and soft tissue (16%), ears/eyes/nose/throat (15%) and the GI tract (9%). No variables evaluated via multivariate analysis, including age, sex, AIDS status, cirrhosis, neutrophil count, use of antiretroviral therapy, CD4 count of the type of interferon treatment received, were significantly associated with infection risk.

Moderate neutropenia (fewer than 1,500 cells/mcL) occurred in 64.6% of cases, while 8.4% experienced severe neutropenia (fewer than 500 cells/mcL). More patients with neutropenia developed infection compared with those without neutropenia, but the difference was not significant (34.3% of severe cases and 32.5% of moderate cases vs. 22.5%; P=.067 for trend).

Serious infection occurred in 4.8% of cases. Prevalence of serious infection was numerically but not significantly greater among patients with severe neutropenia compared with nonsevere or no neutropenia (8.6% vs. 4.8% and 3.6%, respectively; P=.281 for trend). Multivariate analysis did not indicate a significant association between neutropenia and risk for serious infection.

“We … analyzed associated risk factors for infections complications during [peginterferon/ribavirin] treatment in the largest cohort of HIV/HCV coinfected subjects to date,” the researchers wrote. “Our results support previous data showing a lack of association with different risk factors, including neutropenia, and provide new insight by showing no relationship between severe neutropenia and the development of serious infections.”

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