Document 1178
 DOCN  M94A1178
 TI    CD4+ lymphopenia in HIV+ patients ongoing interferon for chronic
       hepatitis C. The HIV/IFN/HCV Spanish Study Group.
 DT    9412
 AU    Soriano V; Bravo RG; Samaniego J; Gonzalez J; Castro AM; Odriozola P;
       Carballo E; Colmenero J; Del Romero J; Pedreira J; et al
 SO    Int Conf AIDS. 1994 Aug 7-12;10(2):191 (abstract no. PB0778). Unique
       Identifier : AIDSLINE ICA10/94371397
 AB    Recent reports have pointed that some HIV+ patients ongoing IFN therapy
       for chronic hepatitis C (CHC) can experiment a rapid decline of CD4+
       cells, and it has been suggested that IFN could induce autoantibodies
       against some HLA antigens, causing a very rapid drop of CD4+ cells in
       HIV+ patients carrying these HLA haplotypes. We analyze the prevalence
       of this phenomenon, and the possible mechanisms involved in a large
       cohort of HIV+ individuals. In March 1992 a multicenter prospective
       trial was started in Spain, to assess the efficacy and safety of
       recombinant IFN alfa-2b (Intron) in HCV-associated chronic active
       hepatitis in HIV+ persons with CD4+ > 200/microL. IFN was given 5 MU tiw
       during the first 3 months, followed by 3 MU tiw during additional 9
       months. AZT 500 mg daily was given to those patients with 500 CD4+
       cells/microL. 88 patients had been enrolled to December 1993. From 72
       patients (53 men and 19 women) on follow-up for more than 14 weeks, 31
       (43%) achieved complete response (CR). Interestingly, those with > 500
       CD4+ cells/microL achieved CR in 53% (18/34) compared with 34% (13/38)
       of subjects with lower CD4+ count at baseline (p < 0.01). No serious
       side effects or opportunistic infections were observed during the study
       period. However, 4 (5.5%) patients showed a dramatic fall (reduction
       above 100%) in the CD4+ cell count after began IFN therapy. This CD4+
       cell drop was transient or partially reversed after stopping IFN in only
       one of them. Interestingly, all them were male, none had achieved CR
       with IFN therapy, and two were ongoing AZT before began IFN treatment.
       HIV antigenemia in sera collected before start IFN was negative in all
       these patients but one. It remained undetectable and/or becames negative
       in sera collected during IFN therapy in all cases. Thus, the CD4+
       depletion observed in these patients was not associated with an
       enhancement of HIV replication. HLA typing was done in three of these
       individuals, and any of them had the B8 or DR3 antigens. One patient had
       DR1 and the other two had DR10, which is very close antigenically. If
       HLA haplotypes are involved in the mechanisms causing the rapid decline
       of CD4+ cells observed in some HIV+ patients ongoing IFN therapy, other
       HLA antigens than previously reported could be implied. This unexpected
       side effect raise more inquiries on the fitness of IFN therapy for CHC
       in HIV-infected individuals. In the meantime, results of our study
       supports that treatment is well tolerate and useful, but healing is
       particularly restricted to individuals with more than 500 CD4+
       cells/microL.
 DE    Chronic Disease  Comparative Study  Female  Hepatitis
       C/COMPLICATIONS/IMMUNOLOGY/*THERAPY  Human  HIV
       Seropositivity/*COMPLICATIONS/DRUG THERAPY/IMMUNOLOGY  HLA
       Antigens/IMMUNOLOGY  Interferon Alfa-2b/ADVERSE EFFECTS/*THERAPEUTIC USE
       Lymphopenia/*ETIOLOGY/IMMUNOLOGY  Male  Prospective Studies  Spain  T4
       Lymphocytes/*DRUG EFFECTS/IMMUNOLOGY  Zidovudine/THERAPEUTIC USE
       MEETING ABSTRACT  MULTICENTER STUDY

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).