INTERFERON THERAPY OF CHRONIC HEPATITIS-C IN HIV-INFECTED PATIENTS

Objetive. To know the efficiency and tolerance of INF therapy for chro nic virus C hepatitis (HCV) in HIV infected patients compared with non infected patients. Patients and methods. INF-alpha was administered t o 39 patients with chronic hepatitis C virus infection criteria. In 17 cases (43.5%) there was coinfection with HIV. Histologic data were av ailable from 30 patients (75%) and also of viral load during therapy ( Amplicor(R) HCV, Roche Diagnostics) from 8 patients. We determined the response at the end of the first two months of therapy (ER), at the e nd of therapy (FR) and after discontinuation (DR) when the transaminas e level was normalized and viral RNA was not detected in cases when it was measured. The response rates to INF were compared between HIV-pos itive and HIV-negative patients and the secondary effects observed eva luated, as well as tolerance and severity, with a particular emphasis on the CD4 lymphocyte level among HIV-positive patients. Results. An E R was obtained in nive HIV-positive patients (52.9%) and thirteen HIV- negative patients (59%); an FR in eight HIV-positive patients (47%) an d eleven HIV-negative patients (50%), and DR in two HIV-positive patie nts (13.3%) and four HIV-negative patients (28%); although a lower rat e of DR was observed among HIV-positive patients, these differences we re not significant. The disappearance of HCV ARN at the end of therapy was similar for both groups of patients in whom it was measured: five HIV-positive patients (62.5%) and twelve HIV-negative patients (63.1% ). We must consider that HIV-positive patients had a higher number of poor response predictors to INF. Secondary reactions were observed in a higher number of HIV-negative patients (81.8% versus 40.9%) and the level of CD4 lymphocytes was markedly reduced during and after therapy in three patients. Conclusion. INF therapy in chronic hepatitis C vir us infection in HN-positive patients initially has a similar efficienc y to that observed in HIV-negative patients, although perhaps the main tained response rate is lower. A higher number of secondary reactions among HIV-positive patients was not observed, although possible reduct ions in CD4 levels must be considered among these patients. The use of INF in these patients-if properly selected-is therefore not contraind icated.