Interferon alpha treatment of chronic hepatitis C in patients with evidence for co-existent autoimmune dysregulation

Hepatogastroenterology. 1995 Nov-Dec;42(6):900-6.

Abstract

Background/aims: We performed a prospective nonrandomized clinical trial to demonstrate that Interferon (IFN) treatment of individuals with chronic hepatitis C virus (HCV) positive hepatitis (CH-C) and serologic and/or histologic evidence of autoimmune dysregulation is feasible and whether the benefits of successfully treating CH-C are outweighed by the risk of exacerbating Autoimmune Chronic Active Hepatitis (ACAH).

Patients and methods: 23 patients with positive autoimmune dysregulation markers underwent a 6 month course of IFN treatment for chronic HCV hepatitis and were followed for a total of 12 months. Patients were treated with 5 MU of a2b IFN administered subcutaneously 7 days a week for 6 months. Complete blood counts and a panel of liver enzymes were monitored weekly for 4 weeks and then monthly for an additional 11 months (6 months of therapy and 6 months of follow-up). Serum auto-antibodies titers were determined prior to treatment, at the end of the treatment and again after 6 months of follow-up. A liver biopsy was performed prior to, and at the end of treatment and again at 12 months.

Results: Using the standard ALT criteria for defining a response to IFN therapy, 14 (61%) patients experienced a full response and 3 (13%) experienced a partial response. Forty-three percent of the full responders and 33% of the partial responders experienced a relapse during the follow-up. The titer of each of the previously positive autoantibodies either remained unchanged or increased by 1 or 2 dilutions. No clinical exacerbations of a co-existent ACAH were observed.

Conclusions: Individuals with combined CH-C and one or more markers of autoimmune dysregulation can be treated successfully with IFN. Such treatment does not necessarily increase or exacerbate co-existent ACAH and elevate the serum ALT level. In those who clear HCV-RNA as a result of IFN, the liver histology shifts from one consistent with CH-C to resembling ACAH.

Publication types

  • Clinical Trial

MeSH terms

  • Antiviral Agents / therapeutic use*
  • Autoantibodies / analysis
  • Autoimmune Diseases / diagnosis
  • Autoimmune Diseases / immunology*
  • Contraindications
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Hepatitis / diagnosis
  • Hepatitis / immunology*
  • Hepatitis C / immunology
  • Hepatitis C / therapy*
  • Hepatitis, Chronic / immunology
  • Hepatitis, Chronic / therapy*
  • Hepatitis, Chronic / virology
  • Humans
  • Interferon alpha-2
  • Interferon-alpha / therapeutic use*
  • Liver / pathology
  • Male
  • Middle Aged
  • Prospective Studies
  • Recombinant Proteins
  • Risk Factors
  • Time Factors

Substances

  • Antiviral Agents
  • Autoantibodies
  • Interferon alpha-2
  • Interferon-alpha
  • Recombinant Proteins