Some Considerations About Cardiac Toxicity of Combination Therapy for Chronic Hepatitis C

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We read with great interest the recently published article by Almawardy et al entitled " Is Combination Therapy for Chronic Hepatitis C Toxic for Cardiac Function? " (1). They skillfully evaluated 120 cases with hepatitis C virus infections treated with a combination protocol consisting interferon gamma (INFg) a or b in addition to Riba-virin and their aimed to evaluate cardiac toxicity of this regiment during six months treatment. They finally concluded that " combination therapy does not cause a significant deterioration in cardiac function in patients with a chronic hepatitis C infection, and it may be used safely in patients without cardiac disease. " It seems that there are some remarks in this paper that it is better to consider. 1) There are various reports about cardiac disorders in patients with hepatitis C. It seems that direct cardiac toxicity of hepatitis C virus can confound the result of this study (2-4). The aim of this study was " to evaluate the effects of combination therapy pegylated interferon and ribavirin on cardiac function in patients with a chronic hepatitis C infection. " It was necessary to eliminate the pure effect of hepatitis C virus on cardiovascular system (such as with adjusting viral load or sustained virological response) to discuss more precisely about combination therapy impacts on heart (5). It also stated that " Adverse effects of Interferon include a cardiac toxicity were reported. " It is better to assessed cardiac toxicity of hepatitis C combination protocol in 3 groups including 1-INFg alone, 2-Ribavirin alone, 3-combination of them. It is possible that there are some synergistic or additive effects between INFg and Ribavirin (6). 2) They assessed these patients' total cardiovascular health using " detailed medical history, thorough clinical examination, 12 lead electrocardiogram (ECG), and echocardiography " but none of them are sufficient for