What is Hepatitis

 How is it Transmitted

 Long Term Prognosis

 Complications of HCV

 Liver Biopsy

 Treatment Info (Interferon, Herbal, etc)

 Lab Tests (PCR, Genotype,etc.)

 Nutrition & Alternative Info

 Patient Information (Support Groups, Doctor Listing, etc)

 Related Webpages

 Transplant Info

 Site Search

 HCV Webrings

 My guestbookbook

 Site Awards

 FAQ & Disclaimers

ALT evalation two months into therapy predicts outcome

ALT evaluation during the second month of interferon treatment is a simple and inexpensive method of identifying chronic hepatitis C patients who will fail therapy, according to a report from Italy.

The report was one of several examining the predictive value of ALT during therapy for chronic hepatitis presented at the VII International Symposium on Viral Hepatitis, held January 25-27, 1996 in Madrid, Spain.

Researcher O. Fracassetti and colleagues conducted a retrospective evaluation of patients with chronic hepatitis C and no signs of cirrhosis treated with interferon-alpha (IFN-(alpha)), with particular regard to the association between changes in serum ALT levels during the first months of treatment and response to therapy.

A total of 170 patients (105 males and 65 females, mean age 45 years), who were HBsAg and HIV negative and HCV antibody positive by ELISA and RIBA methods, were included in the study. The subjects were treated between 1988 and 1993 for histologically proven chronic active hepatitis C with no histological signs of cirrhosis. The disease course of patients was retrospectively evaluated in order to assess early- and long-term response to IFN-(alpha) treatment and the possible predictive value for outcome of serum ALT level changes during the first months of treatment.

A total of 134 patients received conventional doses of recombinant or lymphoblastoid IFN-(alpha) (CD: 3 MU t.i.w. for 12 months), whereas 36 patients were treated with higher doses (HD: 9 MU t.i.w.. for three months and then 3 MU t.i.w. for nine months). Patients were defined as non-responders (NR), whose ALT did not normalize within the fourth month of therapy; primary responders (PR), who presented with normal ALT at the end of therapy; relapsers (RR), whose ALT raised again during follow-up; long-term responders (LTR), who presented with persistently normal ALT after at least 12 months of follow-up.

Twenty-six patients with breakthrough after initial response to the treatment were excluded from the analysis. Eighty-four out of 144 patients (58.3 percent) were primary responders (56 percent CD and 68 percent HD), whereas 60 patients were non responders. Three out of 84 primary responders versus all of the non responders (100 percent) had abnormal ATL at the second as well as the fourth month of treatment.

Thirty-one out of 84 primary responders (37 percent) were relapsers (38 percent CD and 31 percent HD); relapses occurred a mean of 2.9 months (range 1-9) after treatment discontinuation.

Fifty-three out of 144 treated patients (36.8 percent) were LTR; serum HCV RNA, detected by PCR method, was positive in nine out of 24 (37. 5 percent) tested LTR.

"We observed a higher rate of long-term responses after IFN-(alpha) treatment of chronic hepatitis C than reported in literature (36.8 percent versus 18-25 percent), probably because we excluded patients with cirrhosis from the evaluation," Fracassetti et al. wrote in an abstract presented at the Madrid conference. "We observed that ALT normalization at the second month of treatment in this population is a simple, efficient and inexpensive method for identifying patients who will take advantage from IFN-(alpha) treatment; furthermore, ALT are useful independently from the knowledge of viral genotype or viremia levels at baseline. In contrast, they do not seem to be useful in order to identify LTR, whereas normal ALT associated with loss of viremia within the second month of treatment are probably predictive of long-term response."

The corresponding author for this study is O. Fracassetti, Division of Infectious Diseases and Department of Pathology, Ospedali Riuniti, Bergamo, Italy.

Hepatitis Weekly, 03-11-1996, pp 4.

Home | What is HCV | Transmission | Future | Complications | Biopsy | Treatment | Lab | Nutrition | Patient | Links | Transplant | Webrings | guestbookbook | Awards | FAQ |