BREAKTHROUGH DURING INTERFERON THERAPY FOR CHRONIC HEPATITIS-C - OVERVIEW ON THE DIAGNOSIS, POSSIBLE ETIOLOGY AND RECOMMENDATIONS FOR MANAGEMENT

A relapse of serum aminotransferase levels after complete normalisatio n during alpha interferon therapy for chronic hepatitis C is diagnosed as Breakthrough. Its prevalence ranges between 14% and 21% of the res ponders, with no significant differences between the alpha interferons . Hepatitis C virus genotype and interferon dose do not seem to repres ent predisposing factors. The development of neutralising antibodies t o interferon is associated with Breakthrough in about half of the pati ents; other aetiologic factors such as down-regulation of interferon r eceptors or development of virus resistance to interferon may be impli cated in the remaining cases. The therapeutic switch from recombinant to lymphoblastoid alpha interferon has been demonstrated to be a succe ssful strategy to overcome Breakthrough and to restore a complete resp onse.