INTERFERON-ALFA FOR CHRONIC ACTIVE HEPATITIS-B - LONG-TERM FOLLOW-UP OF 62 PATIENTS - OUTCOMES AND PREDICTORS OF RESPONSE

Objective: To evaluate the response to treatment with interferon alfa and the long term outcome of patients with chronic active hepatitis B. Methods: Sixty-two patients with chronic active hepatitis B (43 males , 19 females; age range, 10-67 years) who were treated with interferon alfa at Westmead Hospital between 1984 and 1992 were followed up (mea n period of follow-up, 44 months). Thirty-nine patients were treated w ith interferon alfa-2a and 23 with interferon alfa-2b for a mean of 22 .5 weeks. Interferon was given three times a week with a dose range of 3-21 million U. We evaluated pretreatment predictors of response (pat ient's age, sex, ethnic origin, presence of cirrhosis, serum levels of alanine aminotransferase [ALT] and hepatitis B virus DNA [HBV-DNA]) a nd the effect of dose and type of interferon. Results: Nine patients h ad a complete response to treatment with interferon alfa (loss of hepa titis B surface antigen), 26 had a partial response (permanently HBV-D NA negative, hepatitis B e antigen to anti-hepatitis Be seroconversion ), eight had a transient response and 19 had no response. All patients with a complete response had normal ALT levels at last follow-up. His tological evidence of hepatic inflammation was significantly reduced i n responders. A high pretreatment ALT level and a low HBV-DNA titre we re both positive predictors of a favourable response. We found no sign ificant difference in the response to different types of interferon or to high or low dose regimens, or in the responses of patients with ci rrhosis. Conclusion: Treatment with interferon alfa was associated wit h prolonged suppression of HBV replication in over half these patients and 14% appear to have been cured of the infection. Suppression of HB V replication is associated with sustained abatement of liver disease.