A Cochrane review [Abstract] 1 included 14 studies with a total of 2 269 subjects with human immunodeficiency virus (none of them was previously treated for chronic hepatitis C). Peginterferon plus ribavirin was more effective in achieving end of treatment and sustained virological response compared with interferon plus ribavirin (5 studies, n=1340) or peginterferon (2 studies, n=714). The benefit of peginterferon plus ribavirin was seen irrespective of HCV genotype although patients with genotype 1 or 4 had lower response rates (27%) than patients with genotype 2 or 3 (56%). The overall mortality was 23/2111 patients with no significant differences between treatment regimens. Treatment increased the risk of adverse events including anaemia and flu-like symptoms, and several serious adverse events occurred including fatal lactic acidosis, liver failure, and suicide due to depression.
Comment: The quality of evidence is downgraded by study quality (lack of blinding and considerable loss to follow-up) and by indirectness (lack of direct comparison against no treatment or placebo, and lack of data on important patient-oriented outcomes).
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