Published online Sep 15, 1996. doi: 10.3748/wjg.v2.i3.179
Revised: August 5, 1996
Accepted: August 24, 1996
Published online: September 15, 1996
AIM: To probe the effect of interferon in combination with ribavirin on the plus and minus strands of hepatitis C virus RNA (HCV RNA).
METHODS: Twenty-three cases diagnosed as chronic hepatitis C (CHC), according to positive HCV RNA/anti-HCV, fluctuating levels of aminotransferase activities (< 1 year), and absence of other hepatitis virus marker, were studied. Among them, 13 patients received combined antiviral therapy (subcutaneous injection of 3 MU of interferon-α three times per week for 3 months and intravenous drip of 1 g of ribavirin per day during the first month of treatment with interferon), and 10 patients received single interferon therapy, as described above, as control. The plus and minus strands of HCV RNA in sera and peripheral blood mononuclear cells (PBMCs) of these patients were tested by nested reverse transcription-polymerase chain reaction (nested RT-PCR).
RESULTS: At the end of therapy, the abnormal alanine amino-transferase (ALT) levels decreased to normal range in nine (69.23%) cases in the combined antiviral group. Of them, five (55.56%) experienced post-therapy relapse, and four (44.44%) were complete responders. In the interferon group, ALT decreased to normal in six (60%) cases, of which, four (66.67%) had post-therapy relapse and two (33.33%) were complete responders. The differences between the two groups were not significant (P < 0.05). At the end of therapy, the positive rate of the plus strand in sera decreased from 92.30% to 38.46% (P < 0.05) and that of the minus strand in PBMCs from 76.92% to 38.46% (P < 0.05) in the combined antiviral group. In the interferon only group, the former decreased from 100% to 50% (P < 0.05) and the latter, from 90% to 40% (P < 0.05). Again, no significant differences were found between groups (P < 0.05). Relapse occurred in patients whose plus strand HCV RNA in PBMCs remained after treatment.
CONCLUSION: Ribavirin did not enhance the antiviral effect of interferon when the plus and minus strands of HCV RNA were measured. The absence of HCV RNA in serum does not mean complete clearance of HCV, and its value for evaluating antiviral effects and prognosis is limited. Therefore, it is essential to measure the plus and minus strands of HCV RNA in sera and PBMCs simultaneously.