title: Neutropenia during therapy with peginterferon and ribavirin in HIV-infected subjects with chronic hepatitis C and the risk of infections.
abstract: BACKGROUND
  It is unclear whether pegylated interferon (peg-IFN) -induced neutropenia in subjects coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) is associated with increased risk of serious infections.
  
  
  METHODS
  This was a prospective cohort study conducted between 2000 and 2012 in HIV/HCV-coinfected subjects initiating treatment with peg-IFN plus ribavirin (RBV). Infections were defined as serious when patients required hospitalization, treatment was discontinued, or the patient died. The association between neutropenia (severe, <500 cells/μL; nonsevere, 500 -1500 cells/μL) and infections (serious infections and infections of any severity) was determined by logistic regression analysis.
  
  
  RESULTS
  Among 418 subjects (3928 person-weeks of therapy), infections occurred in 123 (29%), accounting for 149 episodes (3.8 infections per 100 person-weeks of therapy). Most infections (47%) involved the upper respiratory tract and were minor. After a multivariate analysis adjusted by age, sex, CD4 count, AIDS, antiretroviral therapy, cirrhosis, neutrophil count, type of peg-IFN, and granulocyte colony-stimulating factor use, none of these variables remained independently associated with the risk of infection. Twenty subjects developed a serious infection (4.8% of all patients). The frequency of serious infections was higher in subjects with severe neutropenia compared to those with nonsevere neutropenia and without neutropenia, although it was not statistically significant (8.6%, 4.8%, and 3.6%, respectively; trend test P = .281). In multivariate analysis, neutropenia was not independently associated with increased risk of serious infections.
  
  
  CONCLUSIONS
  In this large prospective cohort of HIV/HCV-coinfected patients treated with peg-IFN plus RBV, serious infections were uncommon, nonfatal, and unrelated to peg-IFN -induced severe neutropenia.
authors.affiliation: Department of Infectious Diseases, Instituto de Investigacion Sanitaria del Hospital Ramon y Cajal (IRICYS), Hospital Universitario Ramon y Cajal, Madrid, Spain. serranovillar@gmail.com
authors.forename: Sergio
authors.initials: S
authors.lastname: Serrano-Villar
authors.forename: Carmen
authors.initials: C
authors.lastname: Quereda
authors.forename: Ana
authors.initials: A
authors.lastname: Moreno
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Pérez-Elías
authors.forename: José Luis
authors.initials: JL
authors.lastname: Casado
authors.forename: Ana
authors.initials: A
authors.lastname: Royuela
authors.forename: Fernando
authors.initials: F
authors.lastname: Dronda
authors.forename: Enrique
authors.initials: E
authors.lastname: Navas
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Hermida
authors.forename: Santiago
authors.initials: S
authors.lastname: Moreno
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D004359:Drug Therapy, Combination / Q000009:adverse effects; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000009:adverse effects* / Q000627:therapeutic use*; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced* / Q000276:immunology; D009894:Opportunistic Infections / Q000453:epidemiology*; D011446:Prospective Studies; D012254:Ribavirin / Q000627:therapeutic use*; D018570:Risk Assessment
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin; D007372:Interferons
keywords: HCV; HIV; infections; neutropenia; peginterferon alfa