Ribavirin Therapy Inhibits Viral Replication on Patients With Chronic Hepatitis E Virus Infection
Ribavirin Therapy Inhibits Viral Replication on Patients With Chronic Hepatitis E Virus Infection
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DOI：
10.1053/j.gastro.2010.08.002
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发表时间：
2010-11-01
期刊：
影响因子：
29.4
通讯作者：
Izopet, Jacques
中科院分区：
文献类型：
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作者：
Kamar, Nassim;Rostaing, Lionel;Izopet, Jacques
背景与目的：免疫功能低下患者戊型肝炎病毒（HEV）感染可演变为慢性肝炎。聚乙二醇干扰素可以有效治疗肝移植后的慢性HEV感染，但在肾移植中是禁忌的。我们评估了利巴韦林单药治疗肾移植后慢性HEV感染患者的抗病毒效果。方法：在图卢兹大学医院进行的一项初步研究中，6例接受肾移植的HEV RNA阳性患者（感染HEV 36.5个月；[范围，11-46个月]）接受利巴韦林单药治疗3个月。根据患者清除肌酐的能力，给予600- 800mg /天的利巴韦林，分2次给药。结果：基线时HEV RNA的血清中位浓度为5.77 log copies/mL（范围4.35-7.35 log copies/mL）。在利巴韦林治疗开始3个月后，所有患者的血清样本中都检测不到HEV RNA。4例患者出现持续的病毒学应答；另外2例患者在利巴韦林治疗结束后1个月和2个月复发。在研究结束时，所有患者的丙氨酸和天冬氨酸转氨酶水平正常。贫血是利巴韦林治疗的主要副作用。结论：利巴韦林单药治疗可抑制HEV在体内的复制，并可能在慢性HEV感染患者中诱导持续的病毒学反应。需要进一步的研究来确定利巴韦林治疗的最佳持续时间。
BACKGROUND & AIMS: Hepatitis E virus (HEV) infection can evolve to chronic hepatitis in immunocompromised patients. Pegylated alpha-interferon can effectively treat chronic HEV infection after liver transplantation but is contraindicated for kidney transplantation. We assessed the antiviral effect of ribavirin monotherapy in patients with chronic HEV infection following kidney transplantation. METHODS: In a pilot study performed at Toulouse University Hospital, 6 patients that received kidney transplants who were positive for HEV RNA (infected with HEV for 36.5 months; [range, 11-46 months]) were given ribavirin monotherapy for 3 months. Ribavirin was given at 600-800 mg/day in 2 separate doses, based on the patient's ability to clear creatinine. RESULTS: Median serum concentration of HEV RNA at baseline was 5.77 log copies/mL (range, 4.35-7.35 log copies/mL). Three months after ribavirin therapy commenced, HEV RNA was undetectable in serum samples from all patients. A sustained virologic response was observed in 4 patients; the other 2 patients relapsed at 1 and 2 months after ribavirin therapy ended. At the end of the study, all patients had normal levels of alanine and aspartate aminotransferase. Anemia was the main side effect caused by ribavirin therapy. CONCLUSIONS: Ribavirin monotherapy inhibits the replication of HEV in vivo and might induce a sustained virological response in patients with chronic HEV infections. Further studies are required to determine the optimal duration of ribavirin therapy.