Long-term follow-up of sustained responders to interferon therapy, in patients with chronic hepatitis C

Interferon (IFN) therapy has been proven to induce the normalization of ser um alanine aminotransferase (ALT) levels and to eradicate the hepatitis C v irus (HCV) in some patients with chronic hepatitis C, and these patients ar e usually defined as 'sustained responders'. However, there have been some reports of hepatocellular carcinoma (HCC) in these patients, and the develo pment of HCC remains life-threatening in patients who clear HCV. We analyse d the long-term prognoses of patients with chronic hepatitis C in whom HCV was eradicated with IFN. We investigated 392 sustained responders to IFN th erapy, from 1277 patients with chronic HCV infection who received IFN treat ment at one of our institutions between April 1989 and March 1999. We analy sed the medical records and looked for the development of HCC. About 30% of the sustained responders had been lost to follow-up 3 years after the end of IFN therapy, and the follow-up rate of sustained responders was signific antly lower than that of non-sustained responders (P < 0.0001). HCC were fo und in eight patients: in seven patients HCC developed within 5 years after completion of IFN therapy: but in one patient, a single BCC less than 3 cm in diameter was detected between 7 and 8 years after completion of IFN, Of the five patients who had regular medical follow-up, the HCC was solitary, and the patients survived without any evidence of recurrence. Of the three patients who had not been followed-up, two died from HCC and HCC recurred in the third. These results suggest that HCC can develop in sustained respo nders and that sustained responders should be followed-up closely after com pletion of IFN so that WCC may be detected at an early stage. The optimal d uration of the follow-up period of the sustained responders remains unclear . Additional prospective studies are required in order to establish an appr opriate follow-up protocol for sustained responders to IFN.