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

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 therapycompared 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 therapymay be caused by the immunomodulatory actions of interferon alfa-2.