Increasingly, doctors are using the new, long-lasting form of interferon alpha called peg-interferon (sold under the brand names Pegasys or Peg-Intron) and the drug ribavirin (Virazole) to treat hepatitis C virus (HCV) infection. Sometimes this therapy is given to PHAs who are also using HAART. It is important to note that most HAART regimens contain nukes — AZT, ddI, 3TC and similar drugs — and that the toxicity from nukes is thought to underlie many of the problems seen in the lipodystrophy syndrome. This point is noteworthy because a key part of HCV treatment is the use of the anti-HCV nuke ribavirin (Virazole, Virazid). Therefore, some doctors are concerned that use of ribavirin may intensify certain aspects of the lipodystrophy syndrome, such as fat wasting.
Researchers in France, concerned about this possibility, are studying the impact of HAART and anti-HCV treatment. They reported details on seven subjects who received the following therapy:
Within three months of starting their anti-HCV treatment, the following complications developed:
After three months the following complications developed:
After the subjects stopped their anti-HCV therapy and switched their anti-HIV nuke component of HAART, high levels of lactic acid in the blood did not immediately decline.
High levels of lactic acid and fat wasting are not the only problems that some PHAs face when treated with HAART and anti-HCV drugs. Doctors in Madrid, Spain, reported on 35 subjects (32% female, 62% male) who received peg-interferon (50 micrograms/week) and ribavirin (800 mg/day); 31 of these subjects were also receiving anti-HIV therapy. Over a period of six months the following occurred:
Not surprisingly, anemia was more frequent in subjects who were taking AZT as part of their HAART regimen than in subjects who used d4T instead.
A third group of researchers, also in Madrid, reported on the toxicity of anti-HCV treatment in combination with HAART in 43 co-infected subjects. After an average of nearly six months, three subjects developed signs/symptoms of higher-than-normal levels of lactic acid (hyperlactatemia) including the following:
Readers should note that higher-than-normal levels of lactic acid in the blood can occur without the presence of symptoms. According to the study team, high lactic acid levels occurred in twice as many subjects receiving ddI as compared with other nukes. One subject died as a result of complications from hyperlactatemia.
REFERENCES
1. Kakuda TN, Brinkmann K; Salmon-Céron D, Chauvelot-Moachon L, Abad S, et al. Mitochondrial toxic effects and ribavirin. Lancet 2001 2 June 357;1802-1804.
2. Bentata M, Mansouri R, Honre P and Touam F. Could anti-hepatitis C virus treatment with inteferon alpha and ribavirin enhance or endure lipoatrophy in patients previously treated with anti-HIV multitherapy? Abstract 35 - 3rd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV, 23-26 October 2001, Athens, Greece.
3. Moreno L, Quereda C, Moreno ME, et al. Haematological toxicities of pegylated -interferon plus ribavirin in hepatitis C virus/HIV co-infected patients who received concomitant antiretroviral therapy. Abstract 94 - 3rd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV, 23-26 October 2001, Athens, Greece.
4. Ouereda C, Moreno L, Moreno ME, et al. Symptomatic hyperlactatemia in HIV/Hepatitis C co-infected patients under treatment with interferon-"-ribavirin and antiretroviral therapy. Abstract 103 - 3rd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV, 23-26 October 2001, Athens, Greece.
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