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1Research Center for Gastroenterology and Liver Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran, and 2Baqiyatallah Research Center for Gastroenterology and Liver Disease, Tehran, Iran Address for correspondence: Seyed Moayed Alavian, MD, Gastroenterology and Hepatology, Baqiyatallah Research Center for Gastroenterology and Liver Disease, Vanaq Square, Mola Sadra St. Tehran, Iran. P.O. Box: 14155-3651. Phone: +982188945186, Fax: +982188945188 Gombosova et al reported the occurrence of gastrointestinal abnormalities following treatment by pegylated interferon alpha and ribavirin in a hemophilia case with HCV infection (1). They concluded that treatment with alpha interferon and ribavirin as well as HCV may trigger CD in genetically predisposed subjects (1). The activation of celiac disease (CD) has been reported after the initiation of interferon (IFN-alpha) plus ribavirin in patients with chronic hepatitis C (HCV) (2, 3). However, there is no convincing evidence that patients with viral hepatitis are at increased risk of developing CD (4), but there are contradictory reports on association between celiac disease (CD) and HCV in adults. In a cross-sectional study of 827 pregnant women, 27 (3.26 %) had antibodies against tissue transglutaminase (tTG), and one of them had anti-HCV antibody. Therefore, routine screening of HCV infection in CD patients is not effi cient (5). A recent study of patients having both CD and HCV infection raised the hypothesis that the link between these diseases may be biased by the route of transmission of hepatitis C infection (6). Both interferon and ribavirin may enhance type 1 helper T cell immune responses via signal transducers and activators of the transcription-dependent pathway, which subsequently induces the expression of interferon (2, 3). In some cases combined interferon/ribavirin therapy may manifest a severe clinical form of C (7). It seems that ribavirin plays a critical pathogenic role. Adinolfi et al suggested that ribavirin could also stimulate a subclinical CD by inducing type 1 helper T cell cytokine-mediated immune response and by suppressing the Th2 response (2). Cammarota et al reported 2 cases of chronic hepatitis C that displayed various features of CD during treatment with interferon. Symptoms were improved after starting a gluten free diet and stopping (3).

bratislavské lekárske listy/bratislava medical journal

Should routine screening for celiac disease be considered before starting interferon/ribavirin treatment in patients affected by chronic hepatitis C or not?