ROLE OF THE CD4+ COUNT MONITORING DURING PEGYLATED INTERFERON THERAPY IN

CHRONIC HCV INFECTED PATIENTS

C Popescu, V Arama*, A Hristea, V Molagic, R Moroti, R Nastase, R Mihailescu, D Munteanu, I

Olaru, M Radulescu, I Niculescu, S Gliga, GA Popescu

ObiectiveObiectivess

•The lymphopenia was correlated with the duration of interferon therapy.

•More than 20% of the patients had a CD4 count below 200/mm3 at the end of the treatment.

•About 10% of the patients had a CD4/CD8 ratio below 1. •The CD4+ count may decrease in some patients receiving interferon to levels that increase the risk of opportunistic infections. •The monitoring of CD4 count in patients who developed lymphopenia could be important

Methods Methods

ACKNOWLEDGEMENT: This paper is supported by the Sectoral Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU/89/1.5/S/64109

The treatment of HCV infection has been improved since 2011 after introduction in clinical use of direct

acting antivirals. However, pegylated interferon free regimens are not yet available. That’s why, a good knowledge of pegylated interferon side effects remains very important. Even though hematological

cytopenias are the most frequent adverse effects during interferon treatment, no data exist concerning the decrease of lymphocytes, especially CD4 +.

Describing the variation in lymphocyte and CD4 count

during interferon treatment in order to identify the need

for opportunistic infections prophylaxis.

Conclusions Conclusions

� prospective cohort study of patients receiving

pegylated interferon.

Lymphocyte counts, CD4+,

CD8+, CD4/CD8 ratio

3. Patients with CD4+ below 200/mm3

during treatment

mean value of CD4+ at

baseline was 838.2/mm3

The starting point of the studyIn 2010 we treated an HCV infected patient who developed severe pneumonia

during the last month of interferon therapy. The diagnosis was Pneumocystis

jirovecii pneumonia. The patient had HIV negative status and he had not other

comorbidities which can determine a severe immune suppression. The patient

developed severe lymphopenia after 6 months of interferon therapy. At that

moment, the CD4+ level was 254/mmc and in the ninth month of interferon

therapy the CD4+ was 210/mmc. In the last week of treatment when

pneumonia was diagnosed the CD4 count was 98/mmc and CD4/CD8 ratio was

0.8. The patient received trimethoprim /sulfamethoxazol and the outcome was

favorable.

121 HCV infected

patients treated

with PEG-RBV

were evaluated at baseline, and

after 3, 6, 9 and 12 months of

interferonResultsResults

2. The variation of CD4+ lymphocytes count

3 months 6 months 9 months 12 months

-600

-500

-400

-300

-200

-100

03 months 6 months 9 months 12 months

min mean max

1. The variation of lymphocytes count

the mean decrease was 1442.3/mm3

0.04.5

15.821.9 25.3

0.0

20.0

40.0

60.0

baseline 3 months 6 months 9 months 12 months

4. CD4/CD8 ratio below 1.5 during treatment

p-0.0004

8.30.0

11.82.9

24.2

4.7

32.8

7.3

46.9

10.3

0.0

20.0

40.0

60.0

80.0

baseline 3 months 6 months 9 months 12

months

CD4/CD8<1.5 CD4/CD8 <1