Neutropenia and Infections in People with Hepatitis C

Neutropenia - a low level of neutrophils, a type of immune system white blood cell - is a possible side effect of interferon-based therapy. Experts often discontinue or reduce doses of interferon as patients’ neutrophil counts fall, for fear that neutropenia will lead to infections. However, a study in the June 15, 2006 issue of Clinical Infectious Diseases suggested that low neutrophil counts in individuals receiving hepatitis C treatment are not associated with an increased risk of infection. C.L. Cooper and colleagues followed 192 patients who received 211 courses of therapy for hepatitis C; none used granulocyte colony-stimulating factor (G-CSF, Neupogen) to promote white blood cell production. After a median 17 weeks of therapy, 57 patients (30%) experienced 67 infectious complications, for a rate of 1.17 infections per 100 person-weeks of therapy. The rates of bacterial, viral, and fungal infections did not correlate with nadir (lowest ever) neutrophil counts, or with the magnitude of decline from baseline levels. Infection rates also did not differ based on age, sex, race, body weight, HIV coinfection status, or severity of liver disease. The authors concluded that neutrophil count “is not correlated with infection rate in recipients of interferon-based therapy for hepatitis C,” and suggested that patients who develop neutropenia during hepatitis C treatment may not require interferon dose reduction or adjunct therapy with G-CSF.