Anti-rod and ring antibodies in patients with chronic hepatitis C using direct-acting antivirals


Anti-rods and rings (anti-RR) antibody induction is related to the combination of interferon and ribavirin in the treatment of hepatitis C virus (HCV) infection. If the main factor leading to this autoimmune reaction is the combination of these drugs, is not well known, but in vitro studies shows that ribavirin alone can induce rods and rings structures. New direct-acting antivirals (DAAs) permit HCV treatment without needing interferon but may be associated with ribavirin in the most difficult-to-treat patients. The aim of this study is to evaluate the occurrence of anti-RR in patients with chronic HCV infection, before and after 12 weeks of treatment with DAAs, with and without ribavirin. From Jun 2016 to Oct 2017, 52 HCV-infected patients were screened for anti-RR before and after DAA therapy, including sofosbuvir, daclatasvir, simeprevir, and ribavirin. Serum samples were analyzed using indirect immunofluorescence. The anti-RR was present in 11 (21%) of the 52 patients (51.9% male and mean age of 59.1 years) before using DAAs. All of them had been previously treated and previous exposed to interferon/ribavirin, with exposure time to ribavirin associated with the presence of anti-RR. After 12 weeks of DAA treatment, 3 patients (5.7%) developed the antibody in low titers, and two of them (66%) were interferon/ribavirin experienced. Only one of the 29 naïve patients (3.44%) developed anti-RR during the current treatment. Anti-RR was present in patients previously treated with interferon/ribavirin and can emerge after DAA treatment probably at a lower frequency than after interferon/ribavirin treatment.

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We appreciate the help of Caroline Louise Diniz Pereira with the collection of samples and Emídio Cavalcanti de Albuquerque with the statistical analysis. The English text of this paper has been revised by Sidney Pratt, Canadian, MAT (The Johns Hopkins University), RSAdip—TESL (Cambridge University).

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Correspondence to Ana Beatriz da Silva Sacerdote.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Comitê de Ética do Centro de Ciências da Saúde da Universidade Federal de Pernambuco, CAAE 58349916.1.0000.5208) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Ana Beatriz da Silva Sacerdote, Silvana de Barros Barreto, Edmundo Pessoa Lopes, Norma Arteiro Filgueira, and Andréa Dória Batista. The first draft of the manuscript was written by Ana Beatriz da Silva Sacerdote, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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da Silva Sacerdote, A.B., Filgueira, N.A., de Barros Barreto, S. et al. Anti-rod and ring antibodies in patients with chronic hepatitis C using direct-acting antivirals. Immunol Res 68, 111–117 (2020).

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  • Chronic hepatitis C
  • Autoantibodies
  • IMPDH2 protein
  • Ribavirin
  • Anti-rods and rings
  • Direct-acting antivirals