TreatmentUpdate 68, Volume 8, No 4; May-June 1996
Sean Hosein

Researchers in Spain reported results from a study testing the effect of interferon-alpha on subjects with HCV, some of whom also had HIV. The researchers used "57 [HIV-infected subjects monitored] for at least 8 months." There were 42 men and 15 women and 23 subjects used AZT for "an average of 11 months." No subject had less than 200 CD4+ cells, and the average CD4+ cell count was 560 cells.

All subjects had high levels of liver enzymes--at least twice the normal range--in their blood. As well, all had anti-HCV antibodies and analysis of samples of their liver suggested hepatitis. Subjects received interferon-alpha-2b (Intron Ar, made by Schering Plough) "5 million units [three times weekly] for 3 months." Those subjects who showed improvement when given interferon had their dose reduced to "[3 million units three times weekly] for an additional 9 months." Subjects who had less than 500 CD4+ cells received AZT 500 mg/day.

Results--HIV-infected subjects

* 22 had their liver enzyme levels fall to normal

* 12 had their liver enzyme levels decrease by 50%

* 23 had no decrease

Results--non-HIV-infected subjects

* 10 had their liver enzyme levels fall to normal

* 4 had their liver enzyme levels fall by 50%

* 7 had no decrease

Toxicity--CD4+ cell counts

Three HIV-infected subjects had a "dramatic fall of CD4+ cell count[s] after [they began to use interferon-alpha]." When researchers stopped giving the three subjects interferon-alpha two of them continued to have declining CD4+ numbers (researchers did not release the figures). The two subjects "were males" whose liver enzyme levels did not return to normal while in the study. The researchers stated that no side effects or life-threatening infections occurred in this study.

Who benefits?

On average 33% of subjects had a decrease in their CD4+ cell counts while 21% had an increase. This difference was not statistically significant. The "deeper fall in CD4+ cell count[s] was seen at 2-6 weeks after beginning interferon-alpha." Subjects who did not receive AZT (46%) were more likely to have a decrease in their CD4+ cell counts than subjects who received AZT (24%). This difference was statistically significant; that is, not likely due to chance alone. The researchers found that HIV-infected women (69%) were more likely to benefit from interferon-alpha than HIV-infected men (21%). This difference was statistically significant. A similar effect has also been observed in another study using interferon-alpha for treating HCV infection.

Although HIV-infected subjects in this study seemed able to tolerate interferon-alpha, recovery from HCV infection was low, about 39%. The researchers did not release information as to what happened to liver enzyme levels when subjects who improved stopped using interferon-alpha. Nor did they measure levels of HCV. They ended their report by suggesting that doctors need to weigh the advantages of interferon therapy:

* recovery from HCV infection,

against the disadvantages:

* recovery may be temporary;

* CD4+ cell counts may decline faster;

* the drug is expensive;

people may die from other life-threatening conditions seen in AIDS long before complications "of liver disease caused by hepatitis C."

REFERENCES:

1. Soriano V, Garcia-Samaniego J, Bravo R, et al. Efficacy and safety of alpha-interferon treatment for chronic hepatitis C in HIV-infected patients. Journal of Infection 1995;31(1):9-13.

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Copyright © 1996 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284  http://www.catie.ca