2006
DOI: 10.1016/j.hepres.2005.09.039
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Early immune-mediated response to ribavirin combined with IFN in patients with chronic hepatitis C

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Cited by 6 publications
(3 citation statements)
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“…By contrast, treatment with PEG-IFN∝ and ribavirin will result in sustained viral response rates (SVR) of 80–90% after 6 months therapy for HCV genotypes II [36-38] while ~50% of patients with genotype I [3,35], or over double the rate for IFN alone, will experience SVR after 48 weeks PEG-IFN∝ and ribavirin. Paradoxically, despite having little impact on HCV RNA levels, ribavirin does improve serum alanine aminotransferase (ALT) levels in a significant number of patients, with about 30% of patients normalizing their ALT after 24 weeks ribavirin monotherapy and some improvement in ALT levels in 55% [135-138], an observation difficult to reconcile with the notion ribavirin acts as a direct immunomodulator; if ribavirin does alter the CD4 + lymphocyte T H 1/T H 2 subset balance [139,140] to favour a T H 1 response an increased cell-mediated immune response with enhanced clearance of infected cells and an increased ALT might be expected.…”
Section: 0 Mechanisms Of Antiviral Drug Actionmentioning
confidence: 99%
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“…By contrast, treatment with PEG-IFN∝ and ribavirin will result in sustained viral response rates (SVR) of 80–90% after 6 months therapy for HCV genotypes II [36-38] while ~50% of patients with genotype I [3,35], or over double the rate for IFN alone, will experience SVR after 48 weeks PEG-IFN∝ and ribavirin. Paradoxically, despite having little impact on HCV RNA levels, ribavirin does improve serum alanine aminotransferase (ALT) levels in a significant number of patients, with about 30% of patients normalizing their ALT after 24 weeks ribavirin monotherapy and some improvement in ALT levels in 55% [135-138], an observation difficult to reconcile with the notion ribavirin acts as a direct immunomodulator; if ribavirin does alter the CD4 + lymphocyte T H 1/T H 2 subset balance [139,140] to favour a T H 1 response an increased cell-mediated immune response with enhanced clearance of infected cells and an increased ALT might be expected.…”
Section: 0 Mechanisms Of Antiviral Drug Actionmentioning
confidence: 99%
“…Interferon is also associated temporally with development or exacerbation of autommune diseases [145,146]. When administered to HCV infected patients, ribavirin induces an early immune response by peripheral blood CD4+ T cells [140], as well as altering the T helper (Th) 1/TH2 subset balance [139]. However, are these effects necessarily primarily mediated by direct "immune stimulation"?…”
Section: 0 Mechanisms Of Antiviral Drug Actionmentioning
confidence: 99%
“…More importantly, the difference may reflect the lower ribavirin dose used during the initial 8 weeks in ACTG 5071 because the results of other studies suggest that exposure to ribavirin may be critical to achieve an SVR, at least in singly infected patients [104,105]. It has been suggested that this critical role of ribavirin may be related to its ability to induce a CD4+ T-cell-and natural killer cell-mediated HCV-specific immune response [106], although the precise mechanism of this effect is unknown. An additional important lesson learned from these large studies is that HCV treatment does not appear to have a deleterious effect on HIV disease course (as reflected by plasma HIV RNA or CD4+ T-cell counts), at least in the short followup period reported from these studies.…”
Section: Antiviral Therapy In the Coinfected Patientmentioning
confidence: 99%