Resumen de Adherence to highly active antiretroviral therapy as a predictive factor of ribavirin-induced anaemia in hiv/hcv coinfected patients

Javier González Bueno, Elena Calvo Cidoncha, JM Praena-Fernández

• Introduction: The biomarker of hepatitis C infection that best correlates with a cure is the achievement of sustained viral response (SVR). Adherence to combination therapy is known to be a crucial factor in achieving SVR. Although there are multiple reasons for failing to adhere, the occurrence of adverse effects associated with peginterferon and/or ribavirin is one of the main reasons. In fact, anaemia is the most common reason for premature treatment discontinuation. It has been reported a significant association between undetectable HIV RNA at the beginning of the antiviral therapy for hepatitis C and development of anaemia. Therefore, the main objective of this study is to determine if patients who are more adherent to HAART suffer a higher incidence of anaemia because of probably increased adherence to ribavirin.

  Method: Retrospective two-center observational study. We reviewed the clinical record of all HIV/HCV coinfected patients treated during a minimum of three months for the HCV infection between 2009 and 2012. Patients were eligible for the study if they had already finished their hepatitis C antiviral therapy and if at the beginning of the therapy they were _> 􀂕18 years, had an undetectable HIV RNA (<50 copies RNA HIV), creatinine 􀂔_< 1.6􀀙 mg/dL and haemoglobin >11 g/dL. We collected demographics, clinical and pharmacotherapy variables. Chi-square test as well as univariate and bivariate logistic regression (95% CI) were performed to examine the role of adherence to HAART on the incidence of anaemia, using IBM SPSS version 20.0.

  Results: Fifty-three patients were included in the study. Chi-square tests showed that adherence to HAART was significantly (p = 0.04) associated with anaemia. On univariate and bivariate analyses, adherence to HAART (p = 0.04) and baseline haemoglobin (p <0.001) were significantly associated with anaemia. This association lost statistical significance after adjusting for baseline haemoglobin (p = 0.19), CD4 cell count (p = 0.09) or creatinine (p = 0.07􀀚).

  Conclusion: Our study shows that adherence to HAART has an effect on the incidence of ribavirin-induced anaemia. However, it is the baseline haemoglobin the strongest predictive factor