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Papadopoulos C, Panopoulou M, Mylopoulou T, Mimidis K, Tentes I, Anagnostopoulos K. Cholesterol and Phospholipid Distribution Pattern in the Erythrocyte Membrane of Patients with Hepatitis C and Severe Fibrosis, before and after Treatment with Direct Antiviral Agents: A pilot Study. MÆDICA 2020; 15:162-168. [PMID: 32952679 DOI: 10.26574/maedica.2020.15.2.162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objectives: Hepatitis C virus requires and induces changes in liver lipidome for its life cycle. In addition, alterations in plasma and erythrocyte lipidome are observed during a range of chronic liver diseases. Methods: A total of six subjects (three males and three females) were included in our study. All subjects were HCV positive according to virus RNA detection. Erythrocyte ghosts were prepared from blood and collected upon diagnosis and also at the end of the treatment with Direct Antiviral Agents (DAA). Lipids were extracted from the erythrocyte ghosts, and cholesterol and phospholipids were analyzed by thin layer chromatography. A semi-quantitative estimation of cholesterol (CHOL), phosphatidylethanolamine (PE), phosphatidylinositol (PI), phosphatidylserine (PS), phosphatidylcholine (PC) and sphingomyelin (SM) was performed by densitometric analysis of the chromatographs. Results: After the antiviral treatment, PE percentage decreased, whereas the PC/PE and CHOL/PE ratio increased significantly. There were also other weaker differences for CHOL, PI, PS, PC and SM. Before DAA there was a very weak correlation between ALT and PC/PE ratio. In contrast, there was a steep negative correlation between these two parameters after DAA. Conclusion: Red blood cell lipid composition and especially the PC/PE ratio could be a candidate real time biological marker for inflammation resolution during hepatitis C treatment.
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Affiliation(s)
- Charalampos Papadopoulos
- Laboratory of Biochemistry, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Panopoulou
- Laboratory of Microbiology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Theodora Mylopoulou
- Laboratory of Microbiology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Mimidis
- Laboratory of Microbiology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ioannis Tentes
- Laboratory of Biochemistry, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Rapid profiling and quantification of phospholipid molecular species in human plasma based on chemical derivatization coupled with electrospray ionization tandem mass spectrometry. Anal Chim Acta 2018; 1024:101-111. [PMID: 29776536 DOI: 10.1016/j.aca.2018.04.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/13/2018] [Accepted: 04/13/2018] [Indexed: 12/23/2022]
Abstract
In this study, we developed a novel strategy using solid-phase extraction (SPE) coupled with shotgun mass spectrometry (MS) based on trimethylsilyldiazomethane (TMSCHN2) stable-isotope derivatization for rapid profiling and accurate quantification of phospholipids (PLs) in human plasma. HybridSPE-Phospholipid (HybridSPE-PL, zirconia coated silica stationary phase) was used for sample pretreatment via the Lewis acid-base interaction between zirconia and phosphate moiety of PLs. This step allows rapid enrichment and recovery of PLs from human plasma. Afterward, PLs were derivatized with TMSCHN2, which leads to methylation of hydroxyl and amino groups in PLs and allows highly sensitive PL analysis by shotgun MS in positive ionization mode (limit of detection decreased up to 116.67 fold compared to underived PLs). We developed an accuracy quantification method for determination of PL molecular species in biological samples. Two or more PL standards were selected for each PL class and derivatized with TMSCHN2 without stable-isotope coding. They were then used as the internal standards. PLs in biological samples were isotopic derivatized via acid-catalyzed H/D exchange and methanolysis of TMSCHN2. For accurate quantification, a calibration curve for each class of PLs was typically constructed by using the internal standards to normalize the non-uniformity response caused by the differential fragmentation kinetics resulting from the distinct chemical constitution of individual PL species in the biological samples. This newly developed method was used to comprehensively analyze PL molecular species in human plasma samples. It is a promising methodology for rapid profiling and accurate quantification of complex lipid molecules in biological samples.
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Fritsch SD, Weichhart T. Effects of Interferons and Viruses on Metabolism. Front Immunol 2016; 7:630. [PMID: 28066439 PMCID: PMC5174094 DOI: 10.3389/fimmu.2016.00630] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/08/2016] [Indexed: 12/12/2022] Open
Abstract
Interferons (IFNs) are potent pleiotropic cytokines that broadly alter cellular functions in response to viral and other infections. These alterations include changes in protein synthesis, proliferation, membrane composition, and the nutritional microenvironment. Recent evidence suggests that antiviral responses are supported by an IFN-induced rewiring of the cellular metabolism. In this review, we discuss the roles of type I and type II IFNs in regulating the cellular metabolism and biosynthetic reactions. Furthermore, we give an overview of how viruses themselves affect these metabolic activities to promote their replication. In addition, we focus on the lipid as well as amino acid metabolisms, through which IFNs exert potent antiviral and immunomodulatory activities. Conversely, the expression of IFNs is controlled by the nutrient sensor mammalian target of rapamycin or by direct reprograming of lipid metabolic pathways. These findings establish a mutual relationship between IFN production and metabolic core processes.
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Affiliation(s)
| | - Thomas Weichhart
- Institute of Medical Genetics, Medical University of Vienna , Vienna , Austria
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Solas C, Paré M, Quaranta S, Stanke-Labesque F. [Not Available]. Therapie 2016; 66:221-30. [PMID: 27393202 DOI: 10.2515/therapie/2011036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 03/25/2011] [Indexed: 12/17/2022]
Abstract
Ribavirin in combination with pegylated interferon alpha is the current treatment for chronic hepatitis C (HCV). Ribavirin presents a wide inter-individual pharmacokinetic variability and adequate exposure seems crucial for achieving sustained virologic response. Severe anaemia frequently occurred under ribavirin treatment and is a dose-dependent limiting side effect. Several studies have been carried out in HVC-infected or HIV-HCV co-infected patients to evaluate the pharmacokinetic-pharmacodynamic relationships of ribavirin. Achievement of a sustained virologic response, defined as undetectable HCV-RNA six months after the end of treatment, have been significantly associated with ribavirin concentration. A cut-off for the trough concentration of ribavirin ranging between 2-3μg/ml at week 4 has been proposed. A significant correlation has also been reported between ribavirin concentration and the extent of haemoglobin decline. A ribavirin concentration>2μg/ml is significantly associated to an increase risk of severe anaemia. Non randomized studies have shown that therapeutic drug monitoring of ribavirin improve the management of therapeutic response and haematologic toxicity. Therefore, the level of evidence of the therapeutic drug monitoring of ribavirin is recommended.
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Affiliation(s)
- Caroline Solas
- Laboratoire de Pharmacocinétique et Toxicologie, Hôpital de La Timone, Marseille, France.
| | - Maxime Paré
- Laboratoire de Pharmacocinétique et Toxicologie, Hôpital de La Timone, Marseille, France
| | - Sylvie Quaranta
- Laboratoire de Pharmacocinétique et Toxicologie, Hôpital de La Timone, Marseille, France
| | - Françoise Stanke-Labesque
- Laboratoire de Pharmacologie et Toxicologie, Centre Hospitalier Universitaire de Grenoble, BP217, Grenoble, France; INSERM, U1042, Grenoble, France
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Poordad F, Lawitz E, Reddy KR, Afdhal NH, Hézode C, Zeuzem S, Lee SS, Calleja JL, Brown RS, Craxi A, Wedemeyer H, Nyberg L, Nelson DR, Rossaro L, Balart L, Morgan TR, Bacon BR, Flamm SL, Kowdley KV, Deng W, Koury KJ, Pedicone LD, Dutko FJ, Burroughs MH, Alves K, Wahl J, Brass CA, Albrecht JK, Sulkowski MS. Effects of ribavirin dose reduction vs erythropoietin for boceprevir-related anemia in patients with chronic hepatitis C virus genotype 1 infection--a randomized trial. Gastroenterology 2013; 145:1035-1044.e5. [PMID: 23924660 DOI: 10.1053/j.gastro.2013.07.051] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 07/25/2013] [Accepted: 07/30/2013] [Indexed: 01/25/2023]
Abstract
BACKGROUND & AIMS Treatment of hepatitis C virus (HCV) infection with boceprevir, peginterferon, and ribavirin can lead to anemia, which has been managed by reducing ribavirin dose and/or erythropoietin therapy. We assessed the effects of these anemia management strategies on rates of sustained virologic response (SVR) and safety. METHODS Patients (n = 687) received 4 weeks of peginterferon and ribavirin followed by 24 or 44 weeks of boceprevir (800 mg, 3 times each day) plus peginterferon and ribavirin. Patients who became anemic (levels of hemoglobin approximately ≤10 g/dL) during the study treatment period (n = 500) were assigned to groups that were managed by ribavirin dosage reduction (n = 249) or erythropoietin therapy (n = 251). RESULTS Rates of SVR were comparable between patients whose anemia was managed by ribavirin dosage reduction (71.5%) vs erythropoietin therapy (70.9%), regardless of the timing of the first intervention to manage anemia or the magnitude of ribavirin dosage reduction. There was a threshold for the effect on rate of SVR: patients who received <50% of the total milligrams of ribavirin assigned by the protocol had a significantly lower rate of SVR (P < .0001) than those who received ≥50%. Among patients who did not develop anemia, the rate of SVR was 40.1%. Eleven thromboembolic adverse events were reported in 9 of 295 patients who received erythropoietin, compared with 1 of 392 patients who did not receive erythropoietin. CONCLUSIONS Reduction of ribavirin dosage can be the primary approach for management of anemia in patients receiving peginterferon, ribavirin, and boceprevir for HCV infection. Reduction in ribavirin dosage throughout the course of triple therapy does not affect rates of SVR. However, it is important that the patient receives at least 50% of the total amount (milligrams) of ribavirin assigned by response-guided therapy. ClinicalTrials.gov number, NCT01023035.
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Affiliation(s)
- Fred Poordad
- Texas Liver Institute/University of Texas Health Science Center, San Antonio, Texas.
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Sulkowski MS, Poordad F, Manns MP, Bronowicki JP, Rajender Reddy K, Harrison SA, Afdhal NH, Sings HL, Pedicone LD, Koury KJ, Sniukiene V, Burroughs MH, Albrecht JK, Brass CA, Jacobson IM. Anemia during treatment with peginterferon Alfa-2b/ribavirin and boceprevir: Analysis from the serine protease inhibitor therapy 2 (SPRINT-2) trial. Hepatology 2013; 57:974-84. [PMID: 23081753 DOI: 10.1002/hep.26096] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 09/27/2012] [Indexed: 02/06/2023]
Abstract
UNLABELLED Boceprevir (BOC) added to peginterferon alfa-2b (PegIFN) and ribavirin (RBV) significantly increases sustained virologic response (SVR) rates over PegIFN/RBV alone in previously untreated adults with chronic hepatitis C genotype 1. We evaluate the relationship of incident anemia with triple therapy. A total of 1,097 patients received a 4-week lead-in of PegIFN/RBV followed by: (1) placebo plus PegIFN/RBV for 44 weeks (PR48); (2) BOC plus PegIFN/RBV using response-guided therapy (BOC/RGT); and (3) BOC plus PegIFN/RBV for 44 weeks (BOC/PR48). The management of anemia (hemoglobin [Hb]<10 g/dL) included RBV dose reduction and/or erythropoietin (EPO) use. A total of 1,080 patients had ≥1 Hb measurement during treatment. The incidence of anemia was 50% in the BOC arms combined (363/726) and 31% in the PR48 arm (108/354, P<0.001). Among BOC recipients, lower baseline Hb and creatinine clearance were associated with incident anemia. In the BOC-containing arms, anemia was managed by the site investigators as follows: EPO without RBV dose reduction, 38%; RBV dose reduction without EPO, 8%; EPO with RBV dose reduction, 40%; and neither RBV dose reduction nor EPO, 14%. SVR rates were not significantly affected by management strategy (70%-74%), and overall patients with anemia had higher rates of SVR than those who did not develop anemia (58%). Serious and life-threatening adverse events (AEs) and discontinuations due to AEs among BOC-treated patients did not differ by EPO use. CONCLUSION With BOC/PR therapy, SVR rates in patients with incident anemia were higher than nonanemic patients and did not vary significantly according to the investigator-selected approach for anemia management. Prospective studies are needed to confirm this observation.
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Affiliation(s)
- Mark S Sulkowski
- Johns Hopkins University School of Medicine, Baltimore, MD 21287-0003, USA.
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Kakinami L, Block RC, Adams MJ, Cohn SE, Maliakkal B, Fisher SG. Risk of cardiovascular disease in HIV, hepatitis C, or HIV/hepatitis C patients compared to the general population. Int J Clin Pract 2013; 67:6-13. [PMID: 23241046 PMCID: PMC3533243 DOI: 10.1111/j.1742-1241.2012.02953.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND As a result of effective antiretroviral therapy HIV patients are living longer, and their risk of cardiovascular disease (CVD) is a growing concern. It remains unknown whether coinfection with hepatitis C (HCV) changes an HIV person's CVD risk, and how the risks compare to the general population. The objective of this study was to compare the Framingham Risk Score (FRS) and vascular age differences in persons with HIV, HCV or HIV/HCV disease to the general population. METHODS HIV, HCV, and HIV/HCV patients with clinic visits between 2004 and 2009 were sampled from medical clinics in Rochester, NY. Uninfected persons were randomly selected from the National Health and Nutrition Examination Survey (NHANES), and individually matched on gender, race, and age. We stratified by infection group and conducted separate multivariable linear regression analyses between each infection group and the gender, race, and age matched participants from NHANES. RESULTS Rochester patients (HIV = 239, HCV = 167, HIV/HCV = 182) were compared 3 : 1 with the NHANES participants. After controlling for weight, marital status, current pharmacotherapies and the matching variables of gender, race, and age, HIV/HCV patients had a 2% higher general FRS compared with the general population (p = 0.03), and vascular age differences that were 4.1 years greater (p = .01). HCV patients had a 2.4% higher general FRS than the general population (p < .001), and vascular age differences that were 4.4 years greater (p < .001). CVD risk was elevated but not significantly different between HIV patients and the general population. CONCLUSION Cardiovascular disease risk is elevated among HIV/HCV and HCV infected persons compared with the general population.
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Affiliation(s)
- L Kakinami
- Department of Community and Preventive Medicine, University of Rochester, Rochester, NY, USA.
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Vučić V, Arsić A, Takić M, Ristić-Medić D, Glibetić M. DISTRIBUTION OF SERUM PHOSPHOLIPID FRACTIONS IN PATIENTS WITH DIABETES TYPE 2 AND DYSLIPIDEMIA. ACTA MEDICA MEDIANAE 2012. [DOI: 10.5633/amm.2012.0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Vučić V, Arsić A, Takić M, Ristić-Medić D, Glibetić M. RASPODELA FRAKCIJA FOSFOLIPIDA SERUMA U TIPU 2 DIJABETESA SA UDRUŽENOM DISLIPIDEMIJOM. ACTA MEDICA MEDIANAE 2012. [DOI: 10.5633/amm.2012.0302s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Naik GS, Tyagi MG. A pharmacological profile of ribavirin and monitoring of its plasma concentration in chronic hepatitis C infection. J Clin Exp Hepatol 2012; 2:42-54. [PMID: 25755405 PMCID: PMC3940409 DOI: 10.1016/s0973-6883(12)60090-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 02/28/2012] [Indexed: 02/07/2023] Open
Abstract
Chronic hepatitis C (CHC) infection, usually an asymptomatic infection, has long-term serious complications such as cirrhosis, hepatocellular carcinoma, and end-stage liver disease requiring liver transplantation (LT). Several novel drugs against hepatitis C which form part of 'specifically targeted antiviral therapy for hepatitis C' (STAT-C) have been developed. These include NS3/4A protease inhibitors telaprevir, boceprevir, and nucleoside/non-nucleoside polymerase inhibitors (NS5A) which hold promise for future therapy. Despite the development of new anti-hepatitis C virus (HCV) drugs, ribavirin (RBV) remains the single most important drug to prevent relapse and is frequently included among newer regimens being developed with novel small molecule anti-HCV drugs. The current approved treatment is a combination therapy of once weekly subcutaneous pegylated-interferon (PEG-IFN)-α plus body-weight-based oral RBV regimen. The most significant dose-dependent side effect of RBV is hemolytic anemia warranting dose reduction or discontinuation in severe cases compromising sustained virological response (SVR). Monitoring RBV plasma concentration has been challenging due to its peculiar pharmacokinetics and has been done to predict both efficacy and toxicity. Herein, we review the pharmacological profile of RBV and the monitoring of its plasma concentration, monitoring in renal impairment, post-LT, and human immunodeficiency virus (HIV)-HCV co-infection in patients being treated with combination therapy of PEG-IFN-α and RBV.
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Key Words
- ADSS, adenylosuccinate synthetase
- ATP, adenosine-5′-triphosphate
- AUC, area under concentration curve
- BMD, bone mineral density
- Css, concentration at steady-state
- Ctrough, trough concentration
- DAAs, directly acting antiviral agents
- EPO, erythropoietin
- EVR, early virological response
- FDA, Food and Drug Administration
- GTP, guanosine-5′-triphosphate
- HCV
- HCV, hepatitis C virus
- HIV, human immunodeficiency virus
- HPLC, high-performance liquid chromatography
- Hb, hemoglobin
- IFN, interferon
- IMPDH, inosine-5′-monophosphate dehydrogenase
- ITPA, inosine triphosphate pyro-phosphatase
- PEG-IFN, pegylated-interferon
- PSH, protein sulfhydryl
- RBC, red blood cell
- RBV, ribavirin
- RNA, ribonucleic acid
- RSV, respiratory syncytial virus
- RVR, rapid virological response
- STAT-C, specifically targeted therapy for hepatitis C
- SVR, sustained virological response
- TDM
- TDM, therapeutic drug monitoring
- plasma concentration
- ribavirin
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Affiliation(s)
| | - Manoj G Tyagi
- Address for correspondence: Manoj G Tyagi, Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore – 632002, Tamil Nadu, India
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Homma M, Hosono H, Hasegawa Y, Kohda Y. Morphological Transformation and Phosphatidylserine Exposure in Erythrocytes Treated with Ribavirin. Biol Pharm Bull 2009; 32:1940-2. [DOI: 10.1248/bpb.32.1940] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Masato Homma
- Department of Pharmacy, Tsukuba University Hospital
- Department of Pharmaceutical Sciences, University of Tsukuba
| | | | | | - Yukinao Kohda
- Department of Pharmacy, Tsukuba University Hospital
- Department of Pharmaceutical Sciences, University of Tsukuba
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Morello J, Rodriguez-Novoa S, Jimenez-Nacher I, Soriano V. Usefulness of monitoring ribavirin plasma concentrations to improve treatment response in patients with chronic hepatitis C. J Antimicrob Chemother 2008; 62:1174-80. [DOI: 10.1093/jac/dkn421] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Abstract
BACKGROUND AND AIM Current practice guidelines recommend that individuals chronically infected with the hepatitis C virus (HCV) be treated with pegylated interferon plus ribavirin. Ribavirin, however, is associated with serious adverse events (AE), especially anemia. We review its mechanism of action, its importance in treating chronic hepatitis C (CHC) patients, the AE associated with its use, and techniques used to lessen these AE. METHODS Medline searches were performed using the keywords ribavirin and hepatitis, together with the keywords mechanism, anemia, liver transplant, renal function, pharmacokinetics, and dose reduction. Searches of abstracts of recent Digestive Diseases Week, American Association for the Study of Liver Diseases, and European Association for the Study of Liver Diseases meetings were also performed. RESULTS Ribavirin may be effective in treating CHC by affecting the virus or the host; for example by inducing viral mutations, blocking cellular enzymes, or affecting the host immune response. Although the pegylated interferons are the primary drugs used to treat CHC, a combination with ribavirin is more effective than pegylated interferon alone. Ribavirin-associated AE may be lessened by ribavirin dose reductions and by maintenance of the hematocrit. CONCLUSIONS Treatments of ribavirin toxicities, especially anemia, can allow patients to continue full-dose combination therapy with peginterferon and ribavirin, enhancing their probability of attaining a sustained virologic response (SVR). Treatment of CHC should be tailored to individual patients, especially those with renal dysfunction, and should include agents that treat the side-effects of CHC treatment. Monitoring of plasma ribavirin concentrations during treatment may help in the future.
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