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?:abstract
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There is a great debate regarding the usefulness and efficacy of this medication in anti-viral treatment: chloroquine is not included in the panel recommended for HIV treatment, while its modest effect in the therapy of human virus infection is reported for chronic hepatitis C These findings did not allow for its inclusion in the standardised therapeutic protocols for hepatitis C patients The benefits of chloroquine therapy strongly depend on: (i) the age of the patient;(ii) the clinical presentation and (iii) the stage of the COVID-19 disease Noteworthy, the use of this drug is contraindicated in some conditions, particularly the glucose-6-phosphate dehydrogenase (G6PD) deficiency The latter is a condition that has not been deeply taken into account particularly when, on the web, there has been a \'viral\' spread of news emphasizing the safe use and the free availability of chloroquine Therefore, before establishing that the use of chloroquine in the treatment of SARS-CoV-2 could represent a good option in light of such announcements, we should not miss the following important information that limit the friendly access to the drug: (a) G6PD is a housekeeping enzyme that, in the red blood cell (RBC), guarantees the production of NADPH, which is required to preserve glutathione in the reduced state (GSH), (b) G6PD deficiency shows marked genetic heterogeneity In this regard, we have reported more than 186 mutations, (c) G6PD deficiency is a necessary but not sufficient condition for the occurrence of clinical manifestations: the incidence of clinically evident favism in a group of randomly selected enzymopenic individuals resulted to be less than 30%, (d) the estimated number of G6PD-deficient individuals is close to 400 million people worldwide, while the number of pathogenic gene variants is generally concentrated in a small group of variations that can be easily detected in reference laboratories, and (e) as the rate of deficient RBCs in heterozygote carriers is not predictable a priori, potential individual clinical complications can strongly be proportional to the fraction of the number of G6PD-imbalanced RBCs Moreover, the majority of G6PD-deficient subjects do not show clinical manifestations in the steady state and the condition remains undetected until they are exposed to an exogenous haemolytic trigger such as bacterial or viral infections, ingestion of fava beans (favism) or drugs, mainly the hydroxychloroquine
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