Neutropenia-Lymphocyte count associated with infection risk during HCV interferon treatment

Lymphocyte count associated with infection risk during interferon treatment
Melia M. Clin Infect Dis. 2014;doi:10.1093/cid/ciu009.

Adults with hepatitis C who were treated with pegylated interferon and ribavirin for up to 48 weeks commonly experienced moderate, severe or life-threatening infections, according to a report in Clinical Infectious Diseases.

The nadir lymphocyte count, but not the nadir neutrophil count, was associated with the increased risk for infections in the Individualized Dosing Efficacy vs. Flat Dosing to Assess Optimal Pegylated Interferon Therapy (IDEAL) study.

“While the risk of infection associated with severe neutropenia due to chemotherapy among cancer patients and recipients of hematopoietic cell transplants is well-established, most studies have not demonstrated any increased risk among patients who develop neutropenia while receiving [pegylated interferon],” the researchers wrote. “Nevertheless, up to 23% of patients develop acute infections during HCV treatment.”

Patients in the IDEAL study were randomly assigned to varying doses of pegylated interferon with ribavirin for chronic HCV treatment. In this study, the investigators from evaluated the risk for infection among patients with myelosuppression, a common adverse effect of pegylated interferon treatment.

The IDEAL study included 3,070 treatment-naïve patients. Among those, 581 (19%) patients experienced moderate, severe or life-threatening infections, determined by the investigator. In a logistic regression model, female gender, history of depression and nadir on-treatment absolute lymphocyte count were associated with moderate, severe or life-threatening infections. After adjustment, pegylated interferon type (alfa-2a vs. alfa-2b) and nadir absolute neutrophil count were not associated with moderate, severe or life-threatening infections.

“This observation has important implications for the management of patients treated with [pegylated interferon/ribavirin] alone or in combination with other agents,” the researchers wrote. “While further research is needed to confirm this observation, clinicians should carefully monitor the [absolute lymphocyte count] in addition to the [absolute neutrophil count] for patients receiving HCV therapy with [pegylated interferon and/or ribavirin].”

Disclosure: See study manuscript for disclosure information.

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