Published online Nov 21, 2014. doi: 10.3748/wjg.v20.i43.16184
Revised: July 11, 2014
Accepted: July 24, 2014
Published online: November 21, 2014
Core tip: Innate immune tolerance leads to chronic hepatitis C virus (cHCV) infection even as a pro-inflammatory state develops within the liver. The suppression of heme oxygenase-1 (HMOX1) by HCV plays a major role in perpetuating the infection and inflammation. Ribavirin (RBV) therapy, which increases heme delivery to the liver, can overcome this inhibition. HMOX1 induction in Kupffer cells reduces the pro-inflammatory state produced by HCV, whereas HMOX1 induction in hepatocytes decreases viral multiplication and apoptosis. HMOX1-induced in the liver by hemolysis, results in higher sustained viral response (SVR) rates when RBV is used with interferon (IFN) in the treatment of cHCV.