10-year follow-up after interferon-α therapy for chronic hepatitis C

Abstract

Sustained responses to interferon-␣ occur in 10% to 25% of patients with chronic hepatitis C, but the long-term outcome is not well defined. We evaluated the long-term clinical, histological, and virological outcomes of 10 patients with chronic hepatitis C who were treated between 1984 and 1987 with interferon-␣-2b for 52 ؎ 6 weeks (total doses of 492 ؎ 116 MU). Before therapy, all 10 had hepatitis C virus (HCV) RNA, elevations of serum aminotransferases, and chronic hepatitis with fibrosis on liver biopsy. Clinical follow up was 6 to 13 years, and liver biopsies were done 5 to 11 years after initiation of therapy. HCV RNA was assayed by qualitative and quantitative reverse transcriptase-polymerase chain reaction assays. Among 5 patients who had a 6-month sustained response after therapy, all remained HCV RNA negative, and at last follow-up, 4 had normal and 1 minimally elevated serum aminotransferase levels. Liver biopsy specimens were nonreactive for HCV RNA, and all the patients showed improvements in both inflammation and fibrosis and were either normal or had mild, nonspecific inflammatory changes. Among 5 patients without a sustained response, all continued to have HCV RNA in serum and persistent or intermittent aminotransferase elevations. Liver biopsy specimens showed little or no change in necrosis and inflammation; all except 1 patient had progression of fibrosis scores or cirrhosis. All 5 patients had symptoms of chronic hepatitis, 1 underwent liver transplantation, and another had progressive hepatic decompensation. In conclusion, patients with a 6-month posttreatment virological response have a favorable long-term clinical and histological outcome.(HEPATOL-OGY 1998;28:1121-1127.)Non-A, non-B hepatitis was recognized as the major cause of transfusion-associated hepatitis more than 20 years ago, when the discoverers of the hepatitis A virus showed that cases of viral hepatitis not related to hepatitis B were also not attributable to hepatitis A. 1 After more than a decade of intensive research, Houghton and co-workers isolated a fragment of the genome of the hepatitis C virus (HCV) and subsequently cloned and characterized this agent. 2

Regression of Liver Fibrosis in Cases of Chronic Liver Disease Type C: Quantitative Evaluation by Using Computed Image Analysis

“…Termination of the necro-inflammatory reaction after clearance of the underlying etiological factor(s) might result in improvement of liver fibrosis (1,(9)(10)(11)(12)(13)(14). In particular, IFN treatment has been clinically used for infected patients for over ten years in Japan.…”

“…However, recent studies indicated that liver fibrosis is a reversible process despite the potential progression to liver cirrhosis (1)(2)(3)(4)(5)(6). Clinically, we have encountered several patients who showed histopathological improvement of liver fibrosis during long-term follow-up after interferon (IFN) therapy for HCV infection.…”

Hepatitis C Virus Resistance to Antiviral Therapy

“…Long-term follow-up studies showed that the vast majority of the sustained virologic responders are probably cured from HCV infection. [44][45][46] HCV resistance is defined as HCV RNA persistence in serum after therapy. The incidence of HCV resistance to IFN-based therapies varies according to the administered regimen.…”

Effect of anti‐viral therapy for occult hepatitis C virus infection

“…Currently, anti-viral therapy for chronic hepatitis C is successful in approximately 50% of infected patients, resulting in clearance of HCV-RNA from serum, normalization of liver function tests and improvement of liver histology. 11,12 This standard treatment is the combination of pegylated-interferon (1.5 lg/kg subcutaneously once weekly) and ribavirin (800-1200 mg/p.o./day) for 6-12 months. The aim of this work was to study the response to anti-viral treatment in patients with occult HCV infection in order to assess the possible pathogenic effect of occult HCV.…”