Respiratory syncytial virus in hematopoietic cell transplant recipients and patients with hematologic malignancies

Khawaja, Fareed; Chemaly, Roy F.

Side effects associated with oral and aerosolized ribavirin have been reported in prior publications. One of the common side effects associated with aerosolized ribavirin is that patients often complained of feeling "lonely' and seeing "hail" while they were in the scavenger tent. 57 There have been a few reports of hepatotoxicity associated with the use of aerosolized ribavirin. 76, 91 In a randomized, placebo-controlled trial assessing the use of aerosolized ribavirin for the treatment of RSV in HCT recipients, the rates of hepatotoxicity were similar in the two groups, although the sample size was small; 71 no other side effects were noted in the trial. Hepatotoxicity was reported in association with the use of oral ribavirin for the treatment of hepatitis C virus. 92 However, the observed hepatotoxicity was probably due to the coadministration of interferon therapy. 92 In a retrospective study assessing the use of oral ribavirin in immunocompromised patients, including HCT recipients, 79 only one of the 38 patients who received oral ribavirin developed hemolytic anemia and lactic acidosis. The latter was thought to be due to severe gastrointestinal graft-versushost disease. In a recent retrospective analysis comparing outcomes of HCT recipients with RSV infections who received either aerosolized or oral ribavirin, 90 two of 29 (6.9%) patients on oral ribavirin developed new-onset grade 3 or more anemia at day 14 compared to two of 41 (4.9%) patients who received the aerosolized formulation. These studies demonstrate that both aerosolized and oral ribavirin have similar safety profiles.