Necrotizing cutaneous lesions complicating treatment with pegylated-interferon alfa in an HIV-infected patient.
Pegylated interferon alfa is a pegylated formulation of recombinant human interferon (IFN) conjugated with polyethylene-glycol (PEG). The major advantages of this formulation, compared to standard IFN, is a prolonged half-life which allows for once-weekly injection. Its antiviral efficacy in association with ribavirin as a new standard treatment of chronic hepatitis C has been recently documented. Efficacy of PEG-IFN in the therapy of HIV infection is currently being evaluated in prospective pilot studies. We describe herein the first observation of cutaneous necrosis at the sites of PEG-IFN injection in an HIV-infected patient. A 50-year-old man, HIV infected, was treated with antiretroviral bitherapy combining zidovudine and didanosine for 30 months. Weekly subcutaneous injections of PEG-IFN-alpha-2b were started at a dose of 1.5 microg/kg. Nine months later, two successive necrotizing cutaneous lesions developed at the site of injection. The cutaneous ulcerations slowly healed under local therapy without interruption or dose modification of the PEG-IFN. We review the literature on previously reported cases of cutaneous necrosis following standard or pegylated IFN-alpha injection and discuss the different pathophysiological mechanisms that might be involved.
Bessis
Didier
D
Service de Dermatologie-Phlébologie, CHU Montpellier, Hôpital Saint-Eloi, 80, avenue Augustin-Fliche, 34295 Montpellier Cedex 5, France. d-bessis@chu-montpellier.fr
Charron
Audrey
A
Rouzier-Panis
Régine
R
Blatière
Véronique
V
Guilhou
Jean-Jacques
JJ
Reynes
Jacques
J
D000998:Antiviral Agents / Q000009:adverse effects*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011092:Polyethylene Glycols; D011994:Recombinant Proteins; D012867:Skin / Q000187:drug effects / Q000473:pathology*
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a