Severe strongyloidiasis during interferon plus ribavirin therapy for chronic HCV infection

Ribavirin is a nucleoside analogue, recently introduced in hepatitis C viru s (HCV) therapy, that has postulated immunomodulatory and immunosuppressive action. Strongyloidiasis is an helmintic infection caused by Strongyloides stercoralis, endemic in tropical countries. Severe strongyloidiasis has be en demonstrated after immunosuppression by corticosteroids evolving some fa tal cases. Here, we describe two cases of severe strongyloidiasis coinciden t with ribavirin plus interferon therapy for treating HCV infection, The re view of our monotherapy protocol with interferon did not disclose any case of symptomatic strongyloidiasis pointing to a possible role of ribavirin in modifying immune response to S. stercoralis, We propose a careful screenin g for S. stercoralis before initiating ribavirin therapy or even empiric an tihelmintic treatment. Eur J Gastroenterol Hepatol 12:245-246 (C) 2000 Lipp incott Williams & Wilkins.