Improvement of liver histopathology in patients with hepatitis C after interferon and ribavirin combination therapy

Aim of the study was to evaluate the effect of interferon and ribavirin combination therapy on liver histopathological outcomes.

Pre-treatment and post 24-week treatment liver biopsy specimens were available in 68 naive patients, 37 nonresponders and 18 relapsers after interferon monotherapy. For all patients paired liver biopsies (6-month interval) were assessed for necroinflammation (according to the method by K. Ishak), fibrosis (according to METAVIR score) and steatosis at the end of 24-week treatment.

Virological end-of-treatment response was: 36.8% in naive patients, 24.3% in nonresponders and 22.2% in relapsers. Out of 38 patients, who achieved virological end-of-treatment response, sustained virological response was in 65.8%. There was obvious drop of histological activity features scores in all treated patients at the end of 24-week treatment period. According to the baseline findings, only confluent necrosis was found to be significantly lower in patients, who achieved virological end-of- treatment response (p<0.05). The fibrosis and steatosis has not been influenced at least by 24-week treatment success. But in patients, who achieved sustained virological response, fibrosis was lower at baseline and after 24-week of interferon and ribavirin therapy (p<0.001). In conclusion, assessment of liver histopathology has real value in the evaluation of therapeutic response. Grade of pre-treatment confluent necrosis could predict virological end-of-treatment response. Lower stage of fibrosis both at baseline and after 24-week treatment period seems to be a predictor of sustained virological response.