Early treatment of acute hepatitis C infection with interferon alfa-2b (IFN
-␣-2b) prevents chronicity in almost all patients. So far, no data are available on the long-term outcome after interferon (IFN) therapy of acute hepatitis C. The aim of this study was to assess the clinical, virological, and immunological long-term outcome of 31 successfully treated patients with acute hepatitis C infection who were followed for a median of 135 weeks (52-224 weeks) after end of therapy. None of the individuals had clinical evidence of liver disease. Alanine aminotransferase (ALT) levels were normal in all but 1 patient. Serum hepatitis C virus (HCV) RNA was negative throughout follow-up, even when investigated with the highly sensitive transcription-mediated amplification (TMA) assay (cutoff 5-10 IU/mL). In addition, no HCV RNA was detected in peripheral blood mononuclear cells (PBMC) of 15 cases tested. The patients' overall quality-of-life scores as determined by the SF-36 questionnaire did not differ from the German reference control cohort. Ex vivo interferon gamma (IFN-␥) ELISPOT analysis detected HCV-specific CD4 ؉ T-helper cell reactivity in only 35% of cases, whereas HCV-specific CD8 ؉ T-cell responses were found in 4 of 5 HLA-A2-positive individuals. Anti-HCV antibody levels decreased significantly during and after therapy in all individuals. In conclusion, early treatment of symptomatic acute hepatitis C with IFN-␣-2b leads to a long-term virological, biochemical, and clinical response. Waning of anti-HCV humoral immunity and presence of HCV-specific CD8 ؉ (but not CD4 ؉ ) T cells highlights the complexity of T-cell and B-cell memory to HCV, which might be significantly altered by IFN treatment. (HEPATOLOGY 2004;40:98 -107.)
C hronic hepatitis C virus (HCV) infection is one of the leading causes of chronic liver disease, affecting about 170 million people worldwide. 1 Acute infection with HCV leads to a chronic course in 55% to 85% of cases. 2 Although chronic HCV infection can be cured in 54% to 56% of cases with pegylated interferon alfa (IFN-␣) and ribavirin, 3,4 there is still no successful treatment option available for the majority of patients infected with HCV genotype 1. Thus, prevention of HCV chronicity seems to be desirable. Early treatment of acute symptomatic HCV infection with interferon alfa-2b (IFN-␣-2b) monotherapy has been shown to be very successful: 98% of cases achieved a sustained virological response after a treatment period of 24 weeks. 5 So far, there are no data available concerning the long-term outcome after treatment of acute hepatitis C with IFN-␣. This might be of special interest because late relapses more than 6 months after spontaneous clearance of acute HCV infection have been described. 6 Therefore, the aim of this study was to assess the clinical, virological, and immunological outcome of 31 patients who were