Histological and virological long-term outcome in patients treated with interferon-α2b and ribavirin for chronic hepatitis C

Long-term virological and histological outcome following interferon-alpha 2b (IFN-alpha 2b) and ribavirin treatment for 24 weeks was studied in 20 patients with chronic hepatitis C who were without a lasting response to IFN as monotherapy. Following combination therapy, sustained virological response (SR) was achieved in 12 patients (i.e. hepatitis C virus (HCV) RNA negative in serum 6months post-treatment). Eleven of these patients remained HCV RNA negative in serum 2 years post-treatment. A virological long-term response (LTR) was more frequent in patients with a previous end-of-treatment response to IFN monotherapy than in non-responders. Liver histology at follow-up, greater than or equal to 24 months post-treatment, showed substantial improvement in patients with a virological LTR to the combination treatment. In all nine patients biopsied at the 2-year followup, liver inflammation had disappeared totally (grade = 0), and the stage (fibrosis) had improved. In contrast, no significant changes in grade or stage were noted in patients with a virological non-LTR to combination treatment. A significant improvement in inflammation was noted, in patients with a virological LTR, from 3.6 to 0.2 (P < 0.01) and in fibrosis from 2.0 to 1.4 (P < 0.05) whereas the corresponding scores for patients with a virological non-LTR did not change significantly, from 3.1 to 1.5 for inflammation and for fibrosis from 1.3 to 1.3. We conclude that patients with chronic hepatitis C who achieve a virological sustained response 6months post-treatment with IFN-alpha 2b and ribavirin will remain virological responders for a followup period of least 24months, concomitant with a disappearance of inflammatory activity and a marked improvement of fibrosis in the liver.