The viral genotype and serum viral level influence the response to
interferon (IFN) treatment in patients with
chronic hepatitis C virus (HCV)
viremia. The aim of this study was to investigate a possible relationship between early virological response and helper T (Th) cell
cytokine expansion by 4 weeks of
ribavirin (RIB) alone followed by IFN and RIB combined in patients with genotype 1b and a high HCV
RNA level, patients reported not to respond well to IFN treatment. Eighty-one patients with genotype 1b and a high HCV
RNA level, over 100 international unit per milliliter (KIU/mL) (by Amplicor HCV Monitor), were assigned to two groups: Group A (N = 40) with a 4-week RIB administration followed by a 24-week combination treatment, and Group B (N = 41) with a 24-week combination treatment only. Blood was obtained from each patient on the following schedule: at Baseline (4 weeks before day 0), on day 0 (initiation day of the RIB and IFN combination treatment), weeks 4 (4 weeks after the start of the combination treatment), and at the end of the combination treatment. Flow cytometry was used to investigate sequential changes of IFN-gamma producing (Th1) and
interleukin-4 producing (Th2) cells from whole blood samples after stimulation with PMA and
ionomycin. Serum HCV
RNA clearances were 32.5% at week 4, 43.2% at week 8, 85.7% at the end of the combination treatment, and 22.9% within the 24-week follow-up in Group A; and 17.1%, 27.0%, 66.7% and 19.4% in Group B, respectively. The mean Th1/Th2 ratio significantly increased from 15.9 at baseline to 17.6 at day 0 with a decrease of Th2 cells, and then significantly decreased from 17.6 at day 0 to 15.5 at week 4 in Group A, while there was no significant change in Group B between baseline and day 0. In Group A, 13 patients with HCV
RNA clearance within 4 weeks had a significantly increased Th1/Th2 ratio, from 14.0 at baseline to 22.1 at day 0, and then a significantly decreased ratio, from 22.1 at day 0 to 15.0 at week 4, while the others had no significant change in the ratio. RIB administration preceding combined treatment of RIB with IFN was more effective in Th2 cell expansion than the usual combined treatment of IFN with RIB and led to a relatively early virological clearance in
chronic hepatitis C patients with genotype 1b and a high HCV
RNA level.