Peginterferon plus ribavirin for chronic hepatitis C in patients with human immunodeficiency virus

The aim of this study was to assess the effects of peginterferon plus ribavirin for chronic hepatitis C in patients with human immunodeficiency virus (HIV).

Trials were identified through manual and electronic searches. Randomized trials comparing peginterferon plus ribavirin with other antiviral treatments for patients with chronic hepatitis C and HIV were included. The primary outcome measure was virological response at the end of treatment and after > or =6 months (sustained). Intention-to-treat meta-analyses including data on all patients who were randomized were carried out.

Seven randomized trials were eligible for inclusion. The patients included had chronic hepatitis C and stable HIV and were not previously treated with interferon or ribavirin (treatment naive). The mean dosages were 180 or 1.5 microg/kg once weekly for peginterferon and 800 mg daily for ribavirin. The treatment duration ranged from 24 to 48 weeks. Peginterferon plus ribavirin increased the proportion of patients with an end-of-treatment or sustained virological response compared with interferon plus ribavirin or peginterferon alone. In subgroup analyses of trials comparing peginterferon plus ribavirin with interferon plus ribavirin, the proportion with a sustained virological response was 26% (109 of 423) for patients with genotype 1 or 4 and 57% (130 of 230) for genotype 2 or 3. Several adverse events occurred, including fatal lactic acidosis and liver failure, but there were no significant differences in mortality rates between treatment groups.

Peginterferon plus ribavirin may be considered for treatment-naive patients with HIV and chronic hepatitis C. Adverse events should be monitored carefully.