title: The incidence, predictors and management of anaemia and its association with virological response in HCV / HIV coinfected persons treated with long-term pegylated interferon alfa 2a and ribavirin.
abstract: BACKGROUND
  The association of anaemia with outcomes in the HCV/HIV coinfected persons undergoing HCV treatment remains unclear.
  
  
  OBJECTIVE
  To study the incidence, predictors and management of anaemia, and its association with outcomes among persons treated with pegylated interferon and weight-based ribavirin.
  
  
  METHODS
  Retrospective analysis of a prospective controlled treatment trial of HCV/HIV coinfection.
  
  
  RESULTS
  Among 329 subjects enrolled, 40% developed anaemia during the first 12-18 weeks of treatment (median haemoglobin decrease at week 4: 2.2 g/dL). Among 169 subjects who achieved early virological response and received therapy for 72 weeks, 55% eventually developed anaemia. However, median haemoglobin levels stayed stable after 12-18 weeks of initial therapy. Among these 169 subjects, 45% were prescribed an erythropoiesis stimulating agent (ESA), with 17% receiving it prior to a drop in haemoglobin meeting protocol definition of anaemia. Only 27% completed the study without any ribavirin dose modification. Age >40 years, lower BMI, zidovudine use and lower entry haemoglobin were significant predictors of anaemia in the multi-covariate model. Among all 329, sustained virological response (SVR) rate was similar in those with or without anaemia (23% vs. 30%; P=0.17) with no evidence of association between anaemia or ESA use and treatment response.
  
  
  CONCLUSIONS
  Anaemia is common in HCV/HIV coinfected persons undergoing HCV treatment, and only a minority of them are able to maintain ribavirin dose. Persons with age >40 years, lower baseline haemoglobin and lower baseline BMI should be monitored carefully. Prescription of erythropoiesis stimulating agent is common, but anaemia or erythropoiesis stimulating agent use is not associated with SVR.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, 3601 Fifth Avenue, Pittsburgh, PA 15213, USA. aabutt@pitt.edu
authors.forename: A A
authors.initials: AA
authors.lastname: Butt
authors.forename: T
authors.initials: T
authors.lastname: Umbleja
authors.forename: J W
authors.initials: JW
authors.lastname: Andersen
authors.forename: R T
authors.initials: RT
authors.lastname: Chung
authors.forename: K E
authors.initials: KE
authors.lastname: Sherman
mesh_terms: D000328:Adult; D000740:Anemia / Q000139:chemically induced*; D000998:Antiviral Agents / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance; D011092:Polyethylene Glycols / Q000009:adverse effects; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins; D012254:Ribavirin / Q000009:adverse effects; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015215:Zidovudine / Q000009:adverse effects
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; D015215:Zidovudine; C100416:peginterferon alfa-2a