Carrat F et al. (2004) Pegylated interferon alfa-2b vs standard interferon alfa-2b, plus ribavirin, for chronic hepatitis C in HIV-infected patients: a randomized controlled trial. JAMA 292: 2839–2848

HCV infection is a common problem in patients infected with HIV, but there is a lack of randomized data on current treatments. Carrat et al. have studied the safety and efficacy of ribavirin in combination with peginterferon α-2b or standard interferon α-2b in this setting.

The analysis included 412 patients coinfected with HCV and HIV, who were randomized to ribavirin plus peginterferon α-2b (n = 205) or ribavirin plus standard interferon α-2b (n = 207) for a 48-week period. A sustained virologic response—defined as undetectable serum HCV-RNA at week 72—was significantly more frequent in the peginterferon group than in the standard interferon group (27% vs 20% of patients, P = 0.047). Separate analyses by HCV genotype showed that this difference applied only to patients with HCV genotype 1 or 4; those infected with HCV genotypes 2, 3 or 5 showed similar response rates irrespective of the type of interferon used. The difference at week 12 in HCV RNA levels was a predictor of treatment outcome. The safety and tolerability of the peginterferon and standard interferon regimens were similar, although clinical adverse events or laboratory abnormalities led to significantly more dose modifications in the peginterferon group.

Concluding that peginterferon α-2b was more effective than standard interferon when given in combination with ribavirin to patients coinfected with HIV and HCV, the authors highlight the need for new therapies in this area. They also warn against coadministration of ribavirin in patients receiving the antiretroviral drug didanosine, because mitochondrial toxicity may occur.