I don't think Ribavirin will have a synergistic effect with direct antivirals in vivo since there was another drug designed to replace Ribavirin that showed enhanced Th1 response and limited direct antiviral effect in vitro like Ribavirin, but it failed the clinical trial. As you know many patients have an elevated ISGs before interferon treatment, people have speculated that having more interferon signaling in those patients actually triggers inhibitory pathways for ISG and therefore limits the efficacy of interferon. A recent study then tested the hypothesis to see whether Ribavirin suppresses the inhibitory pathway of ISGs after high dose of interferon and the data suggest its the case.
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