10-YEAR FOLLOW-UP AFTER INTERFERON-ALPHA THERAPY FOR CHRONIC HEPATITIS-C

Sustained responses to interferon-alpha occur in 10% to 25% of patient s with chronic hepatitis C, but the long-term outcome is not well defi ned. We evaluated the long-term clinical, histological, and virologica l outcomes of 10 patients with chronic hepatitis C who were treated be tween 1984 and 1987 with interferon-alpha-2b for 52 +/- 6 weeks (total doses of 492 +/- 116 MU), Before therapy, all 10 had hepatitis C viru s (HCV) RNA, elevations of serum aminotransferases, and chronic hepati tis with fibrosis on liver biopsy. Clinical follow up was 6 to 13 year s, and liver biopsies were done 5 to 11 years after initiation of ther apy, HCV RNA was assayed by qualitative and quantitative reverse trans criptase-polymerase chain reaction assays, Among 5 patients who had a 6-month sustained response after therapy, all remained HCV RNA negativ e, and at last follow-up, 4 had normal. and 1 minimally elevated serum aminotransferase levels, Liver biopsy specimens were nonreactive for HCV RNA, and all the patients showed improvements in both inflammation and fibrosis and were either normal or had mild, nonspecific inflamma tory changes. Among 5 patients without a sustained response, all conti nued to have HCV RNA in serum and persistent or intermittent aminotran sferase elevations. Liver biopsy specimens showed little or no change in necrosis and inflammation; all except 1 patient had progression of fibrosis scores or cirrhosis, All 5 patients had symptoms of chronic h epatitis, 1 underwent liver transplantation, and another had progressi ve hepatic decompensation. In conclusion, patients with a 6-month post treatment virological response have a favorable long-term clinical and histological outcome.