Monitoring plasma ribavirin level during combined antiviral treatment of patients with chronic HCV infection

Introduction: Chronic hepatitis C virus (HCV) infection is more frequent among patients who receive haemodialysis (HD) than that of the general population. In some patients, end-stage renal disease develops from the glomerulonephritis caused by the HCV infection. Equally dangerous is the nosocomial infection during the HD treatment. In both cases, the antiviral treatment is highly recommended, especially for those, who could undergo kidney transplantation. To compare the ribavirin level of patients with renal disease with that of patients with healthy kidney functions, a control group of the latest has been established. Here we report the results of this control group.

Objective: Monitoring plasma ribavirin level of HCV positive patients who receive combined peginterferon alfa-2a or alfa-2b and ribavirin in order to strengthen the safety and efficiency of the treatment.

Patients and methods: Starting September 2008, we have treated 36 patients of chronic HCV infection; 27 of them were naïve patients while 9 received repeated treatment. At every 4 weeks, complete blood test and determination of reticulocyte number, bilirubin, LDH, GPT, creatinine and ribavirin level of the plasma has been performed. The amount of ribavirin has been measured by HPLC method. The studied patients with healthy kidney function received standard of care treatment (weekly dose of peginterferon alfa-2a or alfa-2b and weight based oral daily 800–1600mg ribavirin dose) as response guided therapy.

Results: The age of the 36 patients varied between 21 and 63 year with an average of 49 year. The baseline haemoglobin level was 128±18g/l. At the end of the study, 18 of the total 36 patients (50%) have showen sustained viral response (SVR). Of the 9 patient with repeated treatment 2, while of the 27 naïve patients 16 (59%) has been cured. The plasma ribavirin level has reached 7000ng/ml at the 4th week of the treatment, and this level could be maintained during the next 36 weeks of the treatment.

Conclusion: Standard dose of ribavirin can be safely and efficiently applied to patient with normal kidney function. Their plasma ribavirin levels provide good reference values for the treatment of HCV patients with renal disease.