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44%-65%) and 75% (95% CI, 67%-81%), respectively. As The current goal of interferon treatment for chronic hepatimany as 51% (95% CI, 38%-64%) may have improved, despite tis C is to normalize alanine aminotransferase (ALT) and to failure to normalize ALT. A substantial number of patients eradicate detectable viral RNA. Many patients do not achieve may improve histologically after interferon therapy. The sigthis objective during treatment, and most do not sustain these nificance of histological changes observed after interferon outcomes after interferon is discontinued. However, biochemtherapy must be weighed against the limitations of liver biical or virological responses to interferon may not reflect accuopsy and the uncertain natural history of hepatitis C. Neverrately the histological consequences of therapy. The aim of theless, the ALT does not always reflect liver histology accuthis study was to determine the extent to which the biochemirately after interferon alfa treatment and may underestical measures reflect the histological outcomes in the treatment mate histological improvement. (HEPATOLOGY 1997;26:1035-of hepatitis C with interferon alfa using a meta-analysis of 1044.) diagnostic test characteristics. The data sources were English and non-English language studies retrieved from Medline (from 1966 to December 1995). The sudy selection includedInterferon alfa is widely used in the treatment of hepatitis studies in which interferon alfa was used for treatment of C. Clinically, alanine aminotransferase (ALT) and more rechronic hepatitis C with liver biopsies performed before and cently RNA determinations are used to measure the response after therapy. Data on histological and biochemical outcomes to treatment. However, not all patients normalize their ALT were extracted independently by two reviewers. Two separate during treatment, and only a fraction of responders will suscriteria were used for defining histological response. When tain a normal ALT after interferon is discontinued.1-13 To strict definitions of histological improvement were consid-further complicate matters, the long and variable natural hisered, histology improved in 28% (95% confidence interval tory of the disease 14-16 makes it difficult to establish the true [95% CI], 17%-43%) of patients after interferon treatment. clinical benefit of such biochemical responses. The sensitivity and specificity of the ALT for determiningLiver histology may offer additional insight into disease histological change were 70% (95% CI, 56%-81%) and 66% activity. An improvement in hepatic histology may be seen (95% CI, 56%-75%), respectively. As many as 17% (95% CI, as a favorable response to therapy. Neither ALT nor RNA 9%-30%) of subjects with an abnormal ALT at the end of measures reflect liver histology accurately before interferon therapy may have improved histologically after interferon treatment.17 However, it is currently unclear as to what extent therapy. When less stringent definitions of histological im-biochemical responses after treatment refle...

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