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Hepatic Hepatitis C Virus RNA as a Predictor of a Long-Term Response to Interferon-α Therapy

Michiko Shindo, MD, PhD; Ken Arai, MD, PhD; Yoshihiro Sokawa, PhD; and Tadao Okuno, MD, PhD
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From Akashi Municipal Hospital, Akashi, Japan; and the Kyoto Institutes of Technology, Kyoto, Japan. Request for Reprints: Michiko Shindo, MD, PhD, Department of Internal Medicine, Akashi Municipal Hospital, 1-33 Takashomachi, Akashi, Hyogo, 673 Japan. Acknowledgment: The authors thank Dr. Isao Kamae for discussions about the statistical analyses.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1995;122(8):586-591. doi:10.7326/0003-4819-122-8-199504150-00005
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Objective: To identify predictors of a long-term response to interferon-α therapy in chronic hepatitis C and to determine whether hepatitis C virus (HCV) was eradicated in patients with chronic hepatitis C who had a long-term response to therapy.

Design: A retrospective analysis.

Setting: In- and outpatient liver clinic of a municipal hospital in Japan.

Patients: 47 patients with chronic hepatitis C who responded to interferon-α were divided into two groups: 22 patients with a long-term response (serum aminotransferase levels remained normal for > 1 year after therapy) and 25 patients with a short-term response (serum aminotransferase levels increased again after therapy).

Measurements: Genotyping of HCV, titers of HCV RNA in liver and serum samples (using the reverse transcriptase-polymerase chain reaction), histologic activity index, and liver histologic tests during and 1 year after therapy.

Results: Among the 22 long-term responders, HCV RNA was no longer detectable in liver and serum samples of 21 (95%) at the end of therapy and remained undetectable in the serum of 20 (91%) and in the liver of 19 (86%) 1 year after therapy. Liver histologic tests improved substantially immediately after therapy and 1 year after therapy in the long-term responders; however, 18 (82%) of these patients still had mild, chronic hepatitis. Among the 25 short-term responders, HCV RNA was still detected in the liver of 19 (76%) and in the serum of 9 (36%) at the end of therapy. Multivariate logistic regression analysis showed that the persistent presence of hepatic HCV RNA at the end of therapy was the strongest predictor of relapse.

Conclusion: These findings suggest that HCV infection was eradicated in most of the long-term responders to interferon-α therapy because HCV RNA could no longer be detected in their serum and liver samples and because a significant improvement gradually occurred in their liver histologic results. The persistent presence of hepatic HCV RNA at the end of therapy was the most important predictor of relapse.

Figures

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Figure 1.
Changes in the mean histologic activity index score after interferon-α therapy.Left.Right.

Index scores in the 22 long-term responders before, immediately after, and 1 year after therapy with interferon-α. Index scores in the 25 short-term responders before and immediately after therapy. The bars represent SDs.

Grahic Jump Location

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