Effects of 1-year interferon-alpha 2a treatment in patients with chronic hepatitis C and persistently normal transaminase activity

Background: Certain chronic hepatitis C carriers have persistently normal t ransaminase activity. The aims of this study were to determine the virologi c and histologic effects of 1 year of interferon-alpha treatment in such pa tients. Methods: Thirty-one patients were followed up in our Liver Unit. El even accepted interferon-alpha therapy; the 20 others were not treated and served as controls. Interferon-alpha, 3 MU, was given thrice weekly for 1 y ear. Serum was examined for hepatitis C virus (HCV)-RNA before, at the end of, and 6 months after treatment. Liver biopsy was performed 6 months after the cessation of treatment in 10 of 1 1 treated patients (one refused biop sy) and after a mean of 30.6 +/- 22.7 months in the 20 untreated patients. Results: At the end of follow-up two of the treated patients had undetectab le serum HCV-RNA and five had increased alanine aminotransferase (ALAT) val ues. In contrast, only one of the untreated patients had abnormal ALAT acti vity. All 20 untreated patients were constantly viremic. No significant his tologic improvement was observed in the treated patients evaluated by means of posttreatment liver biopsy. The mean annual progression rate of fibrosi s was very slow and similar in the treated and untreated patients (0.09 (ra nge, 0-0.62) versus 0.07 (range, 0-0.60) fibrosis units). Conclusions: One year of interferon-alpha treatment can suppress HCV-RNA in patients with ch ronic hepatitis C and persistently normal ALAT values followed up over long periods. The rate of fibrosis progression in such patients is very slow, a nd therapeutic strategies should take this fact into account. Antiviral tre atment is debated for patients without fibrosis in initial biopsy specimens .