Risk factors for infection during treatment with peginterferon alfa and ribavirin for chronic hepatitis C.

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Hepatology. 2010 Jul 29. [Epub ahead of print]

Risk factors for infection during treatment with peginterferon alfa and

ribavirin for chronic hepatitis C.

Roomer R, Hansen BE, Janssen HL, de Knegt RJ.

Departments of Gastroenterology and Hepatology, University Medical Center

Rotterdam, Rotterdam, The Netherlands.

Abstract

Neutropenia during treatment with peginterferon alfa and ribavirin for chronic

hepatitis C virus (HCV) infection is a common cause of dose reductions of

peginterferon alfa. These reductions are performed to prevent bacterial and

fungal infections, which are common during HCV treatment and can be attributed

to neutropenia. The aims of this study were to investigate the occurrence of

infections and their relation to neutropenia and to identify potential risk

factors for infections during HCV treatment. In this single-center cohort study,

2,876 visits of 321 patients treated with peginterferon alfa and ribavirin were

evaluated for neutropenia, infections, dose reductions, and potential risk

factors for infection during HCV treatment. The baseline mean absolute

neutrophil count (ANC) was 3,420 cells/ìL, and 16 patients had a baseline ANC of

<1,500 cells/ìL. During treatment, neutropenia, which was defined as ANC <750

cells/ìL, was observed in 95 patients (29.7%) and ANC <375/ìL was observed in 16

patients (5%). Ninety-six infections were observed in 70 patients (21.8%).

Thirteen infections (13.5%) were defined as severe. Infections were not

correlated with neutropenia during treatment. Dose reductions did not lead to a

decrease in infection rate. Multivariate logistic regression analysis revealed

that age >55 years (odds ratio [OR] 2.06, 95% confidence interval [CI]

1.19-3.56, P = 0.01) and baseline hyperglycemia (OR 2.17, 95% CI 1.15-4.10, P =

0.016) were associated with an increased risk of infection during HCV treatment.

Cirrhosis and chronic obstructive pulmonary disease were not risk factors for

infection. Conclusion: Bacterial infections during treatment with peginterferon

alfa and ribavirin are not associated with neutropenia. Older patients and

patients with poorly controlled diabetes mellitus have a greater risk of

developing infections during HCV treatment. (HEPATOLOGY 2010).