Impact of interferon therapy on the natural history of hepatitis C virus related cirrhosis

Background-The role of interferon treatment on the natural history of hepat itis C virus related cirrhosis is under debate. Aim-To evaluate the effect of interferon on the clinical course of compensa ted hepatitis C virus related cirrhosis. Patients and methods-Seventy two c irrhotic patients treated with interferon and 72 untreated controls matched treated patients with for quinquennia of age, sex, and Child-Pugh's score were enrolled in a prospective non-randomised controlled trial. Treated pat ients received leucocytic interferon alfa, with an escalating schedule for 12 months. The incidence and risk (Cox regression analysis) of clinical com plications (hepatocellular carcinoma, ascites, jaundice, variceal bleeding, and encephalopathy) and death were calculated. Results-Over median follow up periods of 55 months for treated and 58 for u ntreated subjects, seven and nine patients, respectively, died, and 20 and 32, respectively, developed at least one clinical complication (ns). Hepato cellular carcinoma developed in six treated and 19 untreated patients (p=0. 018). Seven treated patients showed sustained aminotranferase normalisation and none died or developed complications. Clinical complications were sign ificantly associated with low albumin, bilirubin, and prothrombin activity while hepatocellular carcinoma was significantly related to no treatment wi th interferon, oesophageal varices, and high a fetoprotein levels. By strat ified analysis, the beneficial effect of interferon was statistically evide nt only in patients with baseline a fetoprotein levels greater than or equa l to 20 ng/ml. Conclusions-Interferon does not seem to affect overall or event free surviv al of patients with hepatitis C virus related cirrhosis while it seems to p revent the development of hepatocellular carcinoma. Patients who achieved s ustained aminotransferase normalisation survived and did not develop any co mplications during follow up.