Long-term clinical and virological outcomes of chronic hepatitis C after successful interferon therapy

✍ Scribed by Natsuko Tsuda; Nobukazu Yuki; Kiyoshi Mochizuki; Takayuki Nagaoka; Masatoshi Yamashiro; Masao Omura; Kazumasa Hikiji; Michio Kato

• Publisher: John Wiley and Sons
• Year: 2004
• Tongue: English
• Weight: 260 KB
• Volume: 74
• Category: Article
• ISSN: 0146-6615
• DOI: 10.1002/jmv.20190

✦ Synopsis

Abstract

Clinical relevance of occult hepatitis C virus (HCV) and/or hepatitis B virus (HBV) infection(s) remains uncertain years after interferon (IFN) therapy for chronic hepatitis C. By 1993, 38 sustained virological responders (SVRs) showing HCV RNA clearance at 6 months post‐treatment and 37 biochemical responders (BRs) with end‐of‐treatment alanine aminotransferase (ALT) normalization and subsequent 6‐month stabilization within 2 × the upper limit of normal (ULN) were enrolled. They were monitored for 4.4–12 years (median 6.8), then 15 SVRs and 15 BRs underwent paired liver biopsies. Biopsy samples were tested for positive and negative HCV RNA strands, and HBV DNA surface and X sequences. All SVRs showed sustained serum HCV RNA clearance during follow‐up, but hepatocellular carcinoma (HCC) developed in 4 (11%) SVRs. On paired liver biopsies, histological improvement was significant, but mild inflammation persisted in 87% of SVRs. Nonetheless, no HCV RNA sequence was amplified from liver tissues, and HBV DNA sequences were found in only one SVR. As for BRs, biochemical flare‐up of >2 × ULN occurred at a 5‐year risk of 41% (95% CI 24.7–56.4). The event was unpredictable but controllable by retreatment in 70%. Liver tissues after follow‐up contained positive and negative HCV RNA strands, but no HBV DNA sequence was amplified. These results suggest that SVRs, albeit free of occult HCV and/or HBV infection(s) over a decade, retain mild liver inflammation and the risk of HCC. Occult HBV was also shown uninvolved in flare‐up during follow‐up of BRs. J. Med. Virol. 74:406–413, 2004. © 2004 Wiley‐Liss, Inc.