Nitric oxide levels and sustained virological response to pegylated-interferon alpha2a plus ribavirin in chronic HCV genotype 4 hepatitis: A prospective study.

BACKGROUND The role of nitric oxide (NO) in infectious diseases is gaining attention because of its antiviral effects. AIM To evaluate whether serum and hepatic NO levels are predictors of the outcome of treatment in patients with chronic hepatitis C genotype 4. METHODS Fifty six patients with chronic HCV genotype 4 treated with pegylated interferon (IFN) alpha-2a plus ribavirin underwent blood tests, assessment of serum level of NO and hepatic tissue expression of NO synthase (iNOS) before and during treatment. RESULTS The pre-treatment serum NO level was significantly higher in sustained responders (SR) [39.583 (35-43.8)] compared to relapsers [36.25 (26-43.8)], and non responders (NR) [35.417 (25.0-43.8)]. During treatment, the serum NO level was significantly higher in SR [58.125 (47.9-60.6)] compared to relapsers [53.854 (47.9-59.4)] and NR [50 (42.9-59.4)]. The pre-treatment iNOS expression was significantly higher in SR [37.5 (15-75)] compared with either relapsers [25 (15-45)] and or NR [20 (2-45)]. In multivariate logistic regression analysis, the serum NO was correlated with the virological response to pegylated interferon alpha-2a plus ribavirin therapy. CONCLUSION In patients with chronic hepatitis C, nitric oxide levels may be associated with the outcome of pegylated-IFN-α 2a plus ribavirin treatment.