PROLONGED THERAPY OF CHRONIC HEPATITIS-C WITH RIBAVIRIN

Therapy with ribavirin for 6-12 months is associated with decreases in serum aminotransferases in some patients with chronic hepatitis C. We have assessed the practicality and safety of prolonged therapy with r ibavirin. Six patients with chronic hepatitis C were given 1000-1200 m g of ribavirin daily for 24 months. Serum aminotransferases and hepati tis C virus (HCV) RNA levels were monitored during and after therapy. Liver biopsies were carried out before and at the end of treatment. Wi th therapy, mean serum alanine aminotransferase (ALT) levels fell from 161 U/L to 45 U/L at 12 months and to 39 U/L at 24 months. HCV RNA le vels did not change. Liver histology improved in five and was unchange d in one patient. When therapy was stopped, aminotransferases rose to pretreatment levels. Side effects included mild fatigue and headaches. Two patients developed gallstones during therapy, perhaps caused by t he chronic haemolysis that occurred in all patients. In conclusion, pr olonged therapy with ribavirin can result in sustained improvements in serum aminotransferases and hepatic histology in a proportion of pati ents with chronic hepatitis C. Ribavirin therapy does not cause decrea ses in viraemia and, therefore, probably must be continued indefinitel y to provide lasting benefit. The advantages of such therapy must be w eighed against possible long-term side-effects.