Response to ribavirin in patients with chronic hepatitis c and its relation to HCV genotyping, schistosomiasis and disease severity

ABSTRACT

The association of HCV infection and schistosomiasis is prevalent in Egypt, however its impact on the outcome of therapy for chronic hepatitis C is unclear. Patients and Seventeen patients with biopsy proven chronic hepatitis C. HCV-PCR+ve [5 of them have active cirrhosis] were treated with ribavirin 15 mg/kg/day for 6 months. Histological Activity Index [HAI] and, HCV genotyping, serum IgG for schistosomiasis were done for all the patients 9/17 patients [53%] were genotype 4 and 8/17 [47%] were mixed genotype 2+4 Ribavirin was well tolerated. with minor side effects which were completely reversible. Mean ALT and AST levels were significantly lower than pre-treatment Levels [P<0.01]. complete response [normalization] was observed in 5/17 patients [29.5%] and partial response [50% reduction of ALT] in 8/1 7patients [47%], no response [no substantial changes in ALT] in 4/17 patients [23.5%]. HCV/PCR was negative in 5/17 patients [29.5%] two of them have active cirrhosis, After treatment cessation, HCV PCR becomes positive again and serum ALT returns to pretreatment. levels in all patients. The response to ribavarin was correlated with the presence of schistosomiasis [in 76.5% of patients] but not with the disease severity as graded by knodell s classification where total score of HAI was 12-18 in all patients with no significant differrence between responders and non-responders. Also there was no correlation between the determined genotypes and the response to Ribavarin treatment. Ribavirin is a relatively safe oral drug that could be used for treatment of chronic hepatitis C even in the presence of cirrhosis. But its antiviral effect is not sustained after the end of treatment. The outcome of therapy of chronic hepatitis C could be affected at least partially-by the co-existence of schistosomiasis