Long-term beneficial effects in sustained responders to interferon-alfa therapy for chronic hepatitis C

Background/Aims: Assessment of chronic hepatitis C outcome in sustained res ponders to interferon requires prolonged observation and close monitoring, We prospectively studied the impact of sustained response on histology and clinically relevant outcomes. Methods: The 47 sustained responders (ten with cirrhosis) from two interfer on trials involving 235 chronic hepatitis C patients (81 with cirrhosis) we re included. Hepatitis C virus (HCV) RNA was assessed every 6 months, liver histological changes from baseline, 6-12 and 48-72 months after treatment discontinuation. Results: The mean follow-up was 102 +/- 19 months. HCV RNA became undetecta ble in 36/47 responders, Four responders, who had remained viremic, later r elapsed. The histology progressively improved in non-viremic and viremic pa tients, with a more marked improvement in the former (P=0.0089), normalizin g in 53 vs. 0% (P = 0.0220). No patient progressed to cirrhosis. One non-vi remic cirrhotic patient developed a hepatocellular carcinoma, Non-responder s from the two original trials had worse histological outcomes and those wi th cirrhosis had a higher rate of clinically relevant events compared with cirrhotics showing a sustained biochemical response (4.5 vs. 1.2 cases/100 person-years; CI for the difference, 0.3-6.3). Conclusions: Most sustained, virological responders without cirrhosis norma lize liver histology in the long-term and are cured of the disease. Sustain ed responders remaining viremic still show histological improvement, albeit to a lesser extent. (C) 2001 European Association for the Study of the Liv er. Published by Elsevier Science B.V. All rights reserved.