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Long-term follow up of chronic hepatitis C patients after alpha-interferon treatment: a functional study
E Giannini1, A Fasoli, F Botta
1Department of Internal Medicine, University of Genova, Italy.
Insights
Long-term interferon therapy for chronic hepatitis C (CHC) preserves liver function in responders. Even non-responders and relapsers may experience reduced functional disease progression, as indicated by the monoethylglycinexylidide (MEGX) test.
Area of Science:
- Hepatology
- Virology
- Clinical Medicine
Background:
- Chronic hepatitis C (CHC) poses a significant global health challenge.
- Interferon (IFN) therapy has been a cornerstone treatment for CHC, but its long-term effects on liver function require further evaluation.
- Understanding treatment outcomes is crucial for managing CHC patients effectively.
Purpose of the Study:
- To assess the long-term functional liver outcomes in patients with CHC following interferon therapy.
- To determine if sustained virologic response correlates with preserved liver function.
- To evaluate the utility of the monoethylglycinexylidide (MEGX) test in monitoring CHC patients post-treatment.
Main Methods:
- A cohort of 36 CHC patients receiving IFN therapy were followed for a mean of 36 months.
- Evaluations included biochemical markers, hepatitis C virus (HCV)-RNA, HCV genotype, and the MEGX test at baseline and follow-up.
- Patients were categorized into long-term responders (LTR), relapsers (RR), and non-responders (NR) based on IFN treatment outcome.
Main Results:
- All patients showed an initial decrease in MEGX values.
- Non-responders (NR) and relapsers (RR) exhibited a significant decline in liver function (decreased MEGX values) compared to baseline.
- Long-term responders (LTR) maintained preserved liver function, with normal liver biochemistry and undetectable HCV-RNA at follow-up. NR and RR showed decreased platelets.
Conclusions:
- Sustained response to IFN therapy in CHC patients not only leads to positive clinical and virologic outcomes but also preserves liver function.
- IFN therapy appears to slow the rate of functional liver disease progression, even in patients who do not achieve a sustained response.
- The MEGX test is a valuable non-invasive tool for serial monitoring of liver function in CHC patients undergoing IFN treatment.
Aim:
To evaluate the long-term functional outcome of chronic hepatitis C (CHC) patients treated with interferon (IFN) therapy.
Methods:
Thirty-six patients with CHC were followed up for a mean of 36 months (+/- 19, SD) after a course of IFN therapy. Biochemical, virological (qualitative hepatitis C virus (HCV)-RNA and HCV genotype), and functional (monoethylglycinexylidide (MEGX) test) evaluations were carried out at the time of liver biopsy. Patients were divided into long-term responders (LTR), relapsers (RR), or non-responders (NR) according to IFN therapy outcome. At the end of follow up, patients were non-invasively re-evaluated by means of biochemistry, qualitative HCV-RNA, MEGX test, and liver ultrasonography.
Results:
A significant decrease in MEGX values was observed in all patients. However, when patients were examined according to treatment outcome, only NR and RR showed a significant decrease in liver function as compared to pretreatment levels (MEGX30, 80.5 +/- 26.8-62.9 +/- 24.2 ng/mL, P< 0.01; MEGX60, 72.9 +/- 18.1-60.5 +/- 19.7 ng/mL, P< 0.05; MEGXAUC, 3,816 +/- 1,243-3,095 +/- 1,205 ng/mL per h, P< 0.05). On the contrary, LTR patients showed no significant modifications in MEGX values at each sampling time (MEGX,5, 72.9 +/- 31.4-70.3 +/- 29.7 ng/mL; MEGX30, 84.0 +/- 27.6-71.5 +/- 21.8 ng/ mL; MEGX60, 69.5 +/- 26.8-63.2 +/- 14.4 ng/mL; MEGXAUC 4028 +/- 1,378-3,620 +/- 1,041 ng/mL per h). At the end of follow up, LTR patients showed normal liver biochemistry and negativity of serum HCV-RNA, while NR and RR patients showed a significant decrease in platelets.
Conclusions:
In CHC patients long-term response to IFN therapy, besides favoring positive clinical and virologic long-term outcome, results in maintaining preserved liver function. Furthermore, IFN therapy seems to determine a decrease in the rate of functional disease progression, even in NR and RR. The MEGX test may be considered as a useful tool for performing serial follow up of CHC patients.