Current Hepatitis Reports

, Volume 10, Issue 3, pp 168–178

Ribavirin: How Does it Work and is it Still Needed?


DOI: 10.1007/s11901-011-0102-6

Cite this article as:
Bunchorntavakul, C. & Reddy, K.R. Curr Hepatitis Rep (2011) 10: 168. doi:10.1007/s11901-011-0102-6


Ribavirin is a synthetic guanosine analogue, which acts against hepatitis C virus (HCV) through several mechanisms that include 1) immune modulation; 2) inhibition of inosine monophosphate dehydrogenase 3) inhibition of RNA-dependent RNA polymerase; 4) induction of HCV mutagenesis; and 5) modulation of interferon-stimulated gene expression. Addition of ribavirin to peginterferon-α substantially improves sustained virologic response (SVR) and decreases relapse rates. Ribavirin can be associated with hemolytic anemia. However, recent data suggest that SVR is not negatively impacted by treatment-induce anemia. Notably, optimal dosing strategy and the proper management of anemia are crucial to achieve the best treatment outcome. Several advances have been made in the areas relevant to ribavirin, such as the discovery of inosine triphosphatase gene as a promising pharmacogenetic marker and a predictor of anemia, and the role for erythropoiesis-stimulating agent in the management of anemia related to ribavirin use. Recent observations indicate that ribavirin will remain as a critical component of HCV therapy, even in the context of direct acting antivirals.


RibavirinHepatitis C Virus (HCV)TreatmentSustained Virologic Response (SVR)RelapseMechanisms of actionIMPDH inhibitorMutagenesisRibavirin-induced anemiaHemolysisPegylated interferonPeginterferon-alfaITPA geneTaribavirinInterferon signaling pathwayWeight-based dosingDirect Acting Anti-viral (DAA)Erythropoiesis-stimulating agentEpoetin

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Chalermrat Bunchorntavakul
    • 1
    • 2
  • K. Rajender Reddy
    • 1
    • 2
  1. 1.Division of Gastroenterology and HepatologyHospital of the University of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of MedicineHospital of the University of PennsylvaniaPhiladelphiaUSA