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Long-term liver histology improvement in patients with chronic hepatitis C and sustained response to interferon

Authors


Dr Fabrizio Toccaceli, Dip. Malattie Infettive e Tropicali, Università‘La Sapienza’, Policlinico Umberto I, 00161 Roma, Italy. E-mail: fabrizio.toccaceli@uniroma1.it

Abstract

summary. A retrospective multicentre survey was conducted to evaluate, in patients with chronic hepatitis C, the long-term liver histological changes induced by interferon (IFN). A total of 112 patients (mean age 46.4 years) were studied. All patients had received a 6–12-month IFN-α course (6–18 MU/week) and had successively undergone clinical, biochemical and virological follow-up for at least 36 months (range: 36–76). In each patient, two liver biopsies had been performed: 1–6 months before treatment and, 12–76 months after its completion. In 87 patients with biochemical and virological sustained response persisting for 12 months after therapy, post-treatment liver necroinflammation and fibrosis mean(±SD) scores (Knodell index) were significantly lower than pretreatment scores (2.9 ± 2.2 vs 6.8 ± 2.9 and 0.8 ± 1.0 vs 1.2 ± 1.1, respectively; P < 0.01) . In 25 patients who relapsed within 1 year, necroinflammation and fibrosis post-treatment mean scores were similar to pretreatment scores (7.4 ± 3.2 vs 6.9 ± 3.1 and 1.8 ± 1.3 vs 1.6 ± 1.2, respectively; P > 0.05). On an individual basis, necroinflammation decreased in 87% of sustained responders but only in 36% of relapsers (P < 0.001), whereas fibrosis decreased in 44% of sustained responders but only in 14% of relapsers (P < 0.001). In sustained responders with biopsies performed 12–23 months (n=34), 24–35 months (n=26) or more than 36 months (n=27) after treatment, a progressive decrease of mean necroinflammatory score was observed (−2.6 ± 2.1, −4.1 ± 3.4 and −5.2 ± 3.7 points, respectively; P < 0.01). A similar pattern was observed in fibrosis score (−0.3 ± 0.6, −0.3 ± 0.7 and −0.7 ± 0.9 points, respectively; P < 0.05). Hence, among chronic hepatitis C patients treated with IFN, those with a 12-month sustained response, unlike those who relapse, have a long-term progressive reduction and, in some cases, a complete regression of liver histological damage.

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