Severe Weight Loss Can Be a Side Effect of Interferon-based Therapy in HIV-HCV Coinfected Patients

By Liz Highleyman

Interferon-based treatment for chronic hepatitis C is associated with numerous side effects, and these may be exacerbated in HIV-HCV coinfected patients.

As reported in the April 2008 Journal of Viral Hepatitis, Firouze Bani-Sadr and a team of French investigators conducted a study to determine the incidence of and risk factors for severe weight loss (10% or greater) in HIV-HCV coinfected patients participating in a randomized, controlled trial comparing pegylated interferon alfa-2a (Pegasys) vs pegylated interferon alfa-2b (PegIntron), both in combination with ribavirin for 48 weeks.

As background, the authors noted that weight loss is reported by more than 20% of HCV monoinfected patients treated with the pegylated interferon/ribavirin combination.

Results

• 111 of 383 patients (28.9%) who received at least 1 dose of anti-HCV treatment experienced severe weight loss.

• Among those who took at least 80% of the planned total doses, 74 patients (32.7%) experienced severe weight loss.

• In a multivariate analysis, the following factors were associated with severe weight loss:

• Age greater than 40 years (HR 1.59; P = 0.016);

• Female sex (HR 1.60; P = 0.027);

• Body mass index greater than 22 (HR 1.72; P = 0.0069);

• Use of pegylated interferon alfa-2b (HR 1.82; P = 0.0022);

• Lipodystrophy tended to occur more frequently among patients who experienced severe weight loss than among those who did not (26.1% vs 17.6%; P = 0.0682).

• Patients taking antiretroviral regimens that included a non-nucleoside reverse transcriptase inhibitor (NNRTI) were less likely to experience weight loss (HR 0.62; P = 0.034).

• The 58 patients with weight loss of more than 5% that persisted 24 weeks after the completion of anti-HCV therapy were more likely to be taking stavudine (d4T; Zerit), suggesting that mitochondrial toxicity plays some role.