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Hemolysis is a frequent adverse effect of ribavirin (RBV). It has been suggested that oxidative stress plays a role, but mechanisms and predictive risk factors for severe forms remain unknown. Markers of redox status were determined in erythrocytes of 34 patients with hepatitis C-four of them with glucose-6-phosphate-dehydrogenase (G6PD) deficiency-before and during treatment with RBV and interferon (IFN) and were compared with 10 healthy control subjects. In addition, erythrocytes were incubated with RBV, and the effects of dipyridamole (DPD), diethylmaleate (DEM), and glutathione ester (GSHE) were studied in vitro. Of the 30 patients without G6PD deficiency who were treated with RBV and IFN-alpha, five developed major hemolysis (Delta hemoglobin > 6 g/dL) and 25 developed minor hemolysis (Delta hemoglobin < 2.5 g/dL). Patients with major hemolysis had lower median pretreatment values of membrane protein sulfhydrils than patients with minor hemolysis (28.4 vs. 36.7 nmol/mg, P

Original publication




Journal article



Publication Date





1248 - 1255


Adult, Antiviral Agents, Cell Membrane, Dipyridamole, Erythrocytes, Female, Glutathione, Glutathione Disulfide, Glycogen Storage Disease Type I, Hemolysis, Hepatitis C, Chronic, Humans, In Vitro Techniques, Male, Maleates, Middle Aged, Predictive Value of Tests, Prospective Studies, Ribavirin, Sulfhydryl Compounds