Ribavirin therapy inhibits viral replication on patients with chronic hepatitis e virus infection.
OBJECTIVE
Hepatitis E virus (HEV) infection can evolve to chronic hepatitis in immunocompromised patients. Pegylated α-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.
Kamar
Nassim
N
Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, Toulouse, France. kamar.n@chu-toulouse.fr
Rostaing
Lionel
L
Abravanel
Florence
F
Garrouste
Cyril
C
Lhomme
Sebastien
S
Esposito
Laure
L
Basse
Grégoire
G
Cointault
Olivier
O
Ribes
David
D
Nogier
Marie Béatrice
MB
Alric
Laurent
L
Peron
Jean Marie
JM
Izopet
Jacques
J
D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006508:Hepatitis Antibodies / Q000032:analysis; D016751:Hepatitis E / Q000188:drug therapy* / Q000635:transmission / Q000821:virology; D016752:Hepatitis E virus / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012367:RNA, Viral / Q000032:analysis; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D014779:Virus Replication / Q000187:drug effects*
D000998:Antiviral Agents; D006508:Hepatitis Antibodies; D012367:RNA, Viral; D012254:Ribavirin