PRETREATMENT VIRAL LOAD AND RESPONSE TO PROLONGED INTERFERON-ALPHA COURSE FOR CHRONIC HEPATITIS-C

Background/Aims: We investigated the clinical benefit of long-term int erferon therapy in chronic hepatitis C in relation to the pretreatment viral load and genotypes. Methods: Chronic hepatitis C patients were randomly assigned to receive 28-week (n=45) or 52-week (n=43) courses of interferon-alpha. The responses were correlated with pretreatment v iremic levels assessed by a branched DNA assay and genotypes. Results: After the 28-week interferon-alpha course, sustained aminotransferase normalization showed correlation with a lower initial viral load. The normalization was achieved by 78% (7/9) of the low viremic (branched DNA-negative) patients, but only 22% (8/36) of the highly viremic (bra nched DNA-positive) patients (p<0.01), Treatment with the 52-week inte rferon-alpha course increased the incidence of a sustained response in highly viremic patients and led to a decrease in relapse after therap y withdrawal (p<0.05). Thus, 75% (6/8) of the low viremic patients and 49% (17/35) of the highly viremic patients showed a sustained respons e. The data further showed that frequent sustained responses in patien ts with genotypes III and IV were associated with a low initial viral load. Conclusions: These findings suggest that although the pretreatme nt viral load is an important virological factor for predicting respon ses to interferon in chronic hepatitis C, relapse in highly viremic pa tients may be prevented by long-term therapy.