A HISTOPATHOLOGICAL STUDY OF THE EFFECTS OF 6-MONTH VERSUS 12-MONTH INTERFERON-ALPHA-2B THERAPY IN CHRONIC HEPATITIS-C

Background/Aims: Interferon therapy has been shown to have beneficial effects in chronic hepatitis C, but the optimal duration of treatment has not been clearly defined, The aims of this study were: (a) to perf orm a detailed histological comparison of the effects of a 6-month and a 12-month treatment using the Knodell score as well as a recently pr oposed grid of analysis, (b) to determine possible histological predic tive factors of response to therapy, and (c) to attempt to relate hist ological and biochemical modifications, Methods: Liver biopsies obtain ed before and 18 months after beginning of treatment were therefore co mpared in 26 patients treated for 6 months, and in 34 patients treated for 12 months, Results: Six months of treatment induced a significant decrease in periportal (p=0.02) and intralobular (p=0.004) hepatocyte necrosis, The same items were improved in the 12-month-treated patien ts but, in addition, portal inflammation (p=0.01), bile duct lesions ( p=0.03), lymphoid aggregates (p=0.002) and fibrosis (p=0.008) were als o improved, according to the Knodell score, Low scores for fibrosis, s teatosis and cholangiolar proliferation on the pretreatment liver biop sy could be considered predictive factors for alanine aminotransferase normalization at 6 months, There was no relationship between biochemi cal response and modification of fibrosis. Conclusion: Our results sug gest that: (a) a decrease in fibrosis might be detected only after a 1 2-month interferon treatment, and (b) initial fibrosis, cholangiolar p roliferation and steatosis are predictive of a lack of biochemical res ponse, The absence of a relation between biochemical response and evol ution of fibrosis implies that the evaluation of treatments in chronic hepatitis C should always include a detailed histopathological study.