Histological improvement in chronic hepatitis C patients treated with combination of Alpha-Interferon and ribavirin who failed previously to respond to interferon monotherapy

Abstract

SUMMARY
Background/Aim: Half of the patients infected with hepatitis
C virus (HCV) show no response to alpha-interferon (a-
IFN) and no alternative modality has so far proven to be
effective. Combination of a-IFN with ribavirin has shown
promising results in naive patients and relapsers. The aim
of the present study was to assess the sustained virological
and histological response after combination in 20 chronic
hepatitis patients, non-responders (NR) to a previous a-
IFN monotherapy. Methods: Twenty NR patients were treated
with a-IFN (3MU three times a week subcutaneously)
and ribavirin (1000-1200 mg daily peros) for 48 weeks. Serum
levels of HCVRNA and ALT levels were tested at the
end of treatment and 24 weeks post-treatment while histological
evaluation was done at the end of follow-up. Results:
Genotype was 1a in 2, 1b in 11, 3a in 5 and 4 in 2 patients.
Serum ALT levels normalized in 14 (70%) and HCVRNA
became seronegative in 8 (40%) patients by the end of treatment.
However, six months posttreatment, ALT levels remained
normal in 4(20%) non-responder patients. Serum
HCVRNA was positive in 15 and remained negative in 5
(25%) sustained responder patients. Sustained response rate was 0% in genotype 1, 60% in genotype 3a and 100% in
genotype 4. Necroinflammatory activity improved in 68,4%,
showed no change in 26,3% and worsened in 5,3% cases
(ranked assessment). Treatment was well tolerated and ribavirin
was decreased in 5 (25%) patients. Conclusions: Combination
treatment was well tolerated and the sustained response
rate was 25%, being higher particularly in the non-
1 genotype patients. Induction therapy with a-IFN in combination
with ribavirin should be further evaluated in this
group of patients.
Key Words: Chronic hepatitis C, A-interferon, Cirrhosis,
Ribavirin