Reversible autonomic dysfunction during antiviral treatment in patients with chronic hepatitis C virus infection


Janos Osztovits 1 , * , Evelin Horvath 2 , Judit Tax 2 , Levente Csihi 2 , Tamas Horvath 2 , Levente Littvay 2 , Tamas Toth 2 , Margit Abonyi 2 , Peter L Lakatos 2 , Mark Kollai 2 , Janos Feher 2 , Ferenc Szalay 2 , Hubert E Blum 3

1 First Department of Internal Medicine, Semmelweis University,, Hungary

2 First Department of Internal Medicine, Semmelweis University, Hungary

3 Second Department of Medicine, University of Freiburg, Germany

How to Cite: Osztovits J, Horvath E, Tax J, Csihi L, Horvath T, et al. Reversible autonomic dysfunction during antiviral treatment in patients with chronic hepatitis C virus infection, Hepat Mon. Online ahead of Print ; 11(2):114-118.


Hepatitis Monthly: 11 (2); 114-118
Article Type: Research Article
Received: September 8, 2010
Accepted: November 15, 2010




Background: The first clinical sign of chronic hepatitis C virus (HCV) infection can be one of the various extrahepatic manifestations. During antiviral treatment, symptoms of HCV-associated neuropathies usually improve, but can also worsen and lead to discontinuation of anti-HCV therapy. Recently, we have reported autonomic dysfunction in patients with HCV infection.
Objectives: In the present prospective study, we analyzed the changes of autonomic function during anti-HCV treatment.
Patients and Methods: Cardiovagal autonomic function was assessed in 22 HCV RNA-positive, treatment-naive patients by determining heart rate variability (HRV) and baroreflex sensitivity (BRS), at the beginning of treatment and 12, 24 and 48 weeks of antiviral therapy. interferon alfa-2 and ribavirin were given according to the guidelines.
Results: Both HRV and BRS time and frequency domain indices decreased after 12 weeks of therapy compared to the pre-treatment values; then the mean±SD values increased significantly by week 24 and continued to improve by week 48 of therapy-253.0±156.1 ms before therapy vs 111.6±81.9 at week 12, and 183.4±169.6 at week 24 vs 211.6±149.1 ms at week 48 for low-frequency HRV index; p<0.05 for all comparisons). These changes were independent from the presence of cryoglobulins and from virologic response.
Conclusions: The first rise followed by reversible autonomic dysfunction during antiviral therapy may be caused by the immunomodulatory actions of interferon alfa-2.


Autonomic dysfunction Antiviral treatment Hepatitis C virus

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