Sensitivity to Ribavirin

Some years ago it was shown that ribavirin could block the replication of HDV in primary woodchuck hepatocytes (Choi et al. 1989; Rasshofer et al. 1991). Recent studies confirm that this occurs in cell lines undergoing HDV replication (Chang et al. 2006). Moreover, this inhibition can be achieved with 30 ^M ribavirin, a dose low enough to avoid cell toxicity. In contrast to this, others have cited that ribavirin treatments for HDV-infected patients are not effective (Hoofnagle 1998). However, given that ribavirin treatment is demonstrably selective for HDV replication in cultured cells, further studies in patients maybe warranted. What might seem a possible hindrance to patient studies is that a side effect of ribavirin treatment can be anemia (Galban-Garcia et al. 2000). However, such side effects can be controlled, as judged by the current acceptance of ribavirin (combined with pegylated interferon) as part of a treatment for chronic hepatitis C virus infection. Also, ribavirin might be replaced with viramidine, an immediate precursor to ribavirin, a drug that more specifically targets the liver and should have fewer side effects (Lin et al. 2003). This drug, when applied to cultured cell lines at an appropriate concentration, can also specifically inhibit HDV genome replication (Chang et al. 2006).

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