Patrick Marcellin, MD; Nathalie Boyer, MD; Anne Gervais, MD; Michele Martinot, BS; Michele Pouteau, MD; Corinne Castelnau, MD; Afef Kilani, MD; Jorge Areias, MD; Anne Auperin, MD; Jean Pierre Benhamou, MD; Claude Degott, MD; Serge Erlinger, MD
Less than 20% of patients with chronic hepatitis C have a sustained response to interferon-α therapy. The long-term benefit of interferon-α with regard to hepatic viral clearance and histologic improvement remains unknown.
To determine the long-term biochemical, virologic, and histologic outcomes in patients with chronic hepatitis C who have a sustained response to interferon-α therapy.
Prospective cohort study.
80 patients who had chronic hepatitis C, had a sustained biochemical and virologic response to interferon-α therapy, and were followed for at least 12 months.
Serum hepatitis C virus (HCV) RNA detected by polymerase chain reaction (PCR); HCV genotyping determined by line probe assay; liver histologic studies; liver HCV RNA detected by PCR on frozen liver tissue samples (in 27 patients); and repeated measurements of serum alanine aminotransferase (ALT) levels. Liver biopsy was done before treatment in all 80 patients, and at least one biopsy was done in 69 patients 1 to 6 years after treatment.
The 80 patients had follow-up 1 to 7.6 years (mean ±SD, 4.0 ± 2.0 years) after interferon-α treatment. The follow-up period was 1, 2, 3, 4, 5, 6, and more than 6 years in 11, 13, 14, 18, 10, 12, and 2 patients, respectively, after the end of therapy. During the entire follow-up period, 93% (95% CI, 84% to 97%) of patients had persistently normal serum ALT levels. Serum HCV RNA remained undetectable in 96% (CI, 89% to 99%) of patients. A comparison of liver histologic findings before and 1 to 6.2 years after interferon-α treatment showed a clear improvement in 94% (CI, 83% to 99%) of patients. In 62% of patients, the last biopsy done showed normal or nearly normal histologic findings. Liver HCV RNA was detectable before treatment in all 13 patients tested and was undetectable 1 to 5 years after treatment in all 27 patients tested.
In patients with chronic hepatitis C who have persistently normal serum ALT levels and no detectable serum HCV RNA 6 months after interferon-α therapy, a long-term sustained biochemical and virologic response is generally seen. This response is associated with an absence of detectable intrahepatic HCV RNA and marked histologic improvement.
Marcellin P, Boyer N, Gervais A, Martinot M, Pouteau M, Castelnau C, et al. Long-Term Histologic Improvement and Loss of Detectable Intrahepatic HCV RNA in Patients with Chronic Hepatitis C and Sustained Response to Interferon-α Therapy. Ann Intern Med. ;127:875–881. doi: 10.7326/0003-4819-127-10-199711150-00003
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Published: Ann Intern Med. 1997;127(10):875-881.
Gastroenterology/Hepatology, Infectious Disease, Liver Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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