JAC Advance Access originally published online on March 19, 2008
Journal of Antimicrobial Chemotherapy 2008 61(6):1191-1200; doi:10.1093/jac/dkn119
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Systematic review |
Treatment of chronic hepatitis C in haemophilic patients with interferon and ribavirin: a meta-analysis
1 Hemophilia Center, City Hospital, Verona, Italy 2 Department of Histology, Microbiology and Medical Biotechnology, University of Padua, Padua, Italy 3 Department of Clinical and Experimental Medicine, Section of Hematology, University of Verona, Verona, Italy 4 Center of Preventive Medicine, HIV Outpatient Clinic, Verona, Italy 5 Section of Clinical Chemistry, Department of Morphological and Biomedical Sciences, University of Verona, Verona, Italy
Received 13 December 2007; returned 1 February 2008; revised 20 February 2008; accepted 23 February 2008
* Corresponding author. Tel: +39-045-8123610; Fax: +39-045-8123612; E-mail: massimo.franchini{at}azosp.vr.it
Background: Hepatitis C virus (HCV) infection is a major cause of morbidity and mortality among haemophilic patients who were treated with clotting factor concentrates before the availability of virus-inactivated factors in the mid 1980s. In order to analyse the effect of the current combination anti-HCV treatment [i.e. ribavirin plus interferon (IFN)] in this subset of HCV-infected patients, we performed a systematic review with meta-analysis of the available literature.
Methods: The outcome was sustained viral suppression. When trials included for the main predictors two arms (positive and negative), the effect size was described as a comparative index [odds ratio (OR)] and a standard meta-analytical procedure was applied. However, when trials did not report the outcome in separate study arms, the effect size was a non-comparative index (success rate) and comparisons between predictor-positive and -negative studies were performed by meta-regression.
Results: Data involving 824 haemophilic HCV-infected patients treated with IFN plus ribavirin were collected from 18 articles (14 prospective cohort studies, 1 retrospective study and 3 randomized controlled trials). The higher rate of sustained viral response was observed in human immunodeficiency virus (HIV)-negative naive haemophiliacs treated with pegylated-IFN in combination with ribavirin (61%, ranging from 45% for genotype 1 to 79% for non-1 genotypes). Genotype 1 (OR, 0.15; 95% CI, 0.09–0.25) and co-infection with HIV (OR, 0.25; 95% CI, 0.08–0.81) were strong predictors of worse response to IFN therapy.
Conclusions: Our meta-analysis shows that the pattern of response to combination anti-HCV therapy of chronically HCV-infected haemophiliacs is similar to that achieved in the general HCV-infected population.
Keywords: HCV , haemophilia , response