patients was HCV eradicated, because, in the remain-weakly positive) before therapy have a high rate of sustained response when treated with interferon, in der, HCV RNA was apparently negative from the beginning. Thus, cure was achieved with the aggressive our experience, these patients do not show a significant rate of spontaneous resolution of their liver disease schedule only in 10 of the 44 HCV RNA-positive patients (22.7%)! The results are perhaps encouraging, when left untreated.
- The percentage of patients showing a normal liver but not excellent. Unfortunately, we are not told how many of the 15 initially HCV RNA-negative patients histology without any necroinflammatory activity at the end of follow-up was 8% among the cases showing treated with the aggressive schedule had a sustained biochemical response. In our experience, these patients a sustained response with permanent HCV-RNA clearance. usually show a sustained response, which suggests that perhaps they are already cured, thus not in need of 3. We have recently been able to confirm the good prognosis of sustained responders who are found nega-antiviral treatment. In addition, the authors do not report how many of their patients with a sustained tive for serum HCV RNA 12 months after stopping interferon therapy. In a large series of such cases (85 biochemical response showed normal liver histology (i.e., without necroinflammatory signs) at the end of patients), no late reactivation of hepatitis was found during further follow-up in contrast to a cumulative the follow-up period, but only that an unspecified histological ''improvement'' had occurred after treatment.
risk of greater than 50% in patients who had remained HCV RNA-positive. These findings are to be published Many of the authors' conclusions concerning the superiority of an aggressive schedule of interferon ther-in Annals of Internal Medicine. 1 On the basis of these considerations, we continue to apy are weak, given the above considerations. Moreover, the assumption that disease reactivation is rarely believe that the response to interferon therapy can be improved, at least in a subgroup of patients, by using expected to occur in patients maintaining normal alanine transaminase levels and an absence of viremia a 6-MU dose three times a week for 4 to 6 months, followed, in respondent patients, by a 3-MU dose to for 12 months after interferon withdrawal also awaits confirmation. Unfortunately, current worldwide expe-complete a 12-month treatment period.
As Dr. Angelico has correctly outlined, the cost of rience is increasingly showing that the percentage of interferon-treated HCV-infected patients in whom the interferon therapy is high, but its cost/effectiveness ratio becomes particularly unsatisfactory when the drug virus persistently disappears from the body is much lower than that of earlier reports, so that virus eradica-is given with suboptimal regimens as it was when we were using the 3-MU, thrice-weekly, 6-month schedule. tion cannot be considered a realistic objective of treatment. 2 I believe that more than one word of caution is needed before the advantages of long-term aggressive LILIANA CHEMELLO interferon therapy in chronic hepatitis C can be ac-ALFREDO ALBERTI cepted, expecially in light of the extremely high costs Clinica Medica 2 of this therapeutic approach.