Clinical outcome of chronic hepatitis C in patients treated with interferon: comparison between responders and non-responders.

Aim: To evaluate the prognosis of chronic hepatitis C in relation to interferon therapy response and the persistence of therapeutic benefits.

Patients/methods: We studied the clinical outcome of 191 patients with chronic infection (152 chronic hepatitis C and 39 cirrhosis) treated with recombinant alpha-interferon (3-6 MU on alternate days for 1 year) during a mean period of 47 months (range 22.5-73.8). Control tests were done at 6-month intervals. HCV RNA was determined pre- and post-treatment in all participants, but continued yearly in long-term responders. The appearance of cirrhosis was estimated using a non-invasive method that utilizes a model based on clinical, instrumental and biochemical variables. Ascites, encephalopathy, haemorrhage, hepatocellular carcinoma, and death were considered liver-disease-related events.

Results: A total of 39 patients were long-term responders, 36 relapsers, and 116 non-responders; 92% of long-term responders cleared HCV RNA and remained negative throughout the study period. The 3 HCV-RNA-positive long-term responders continued being so. No biochemical relapse was observed in long-term responders regardless of virological status. New cirrhosis was observed in 3/30 relapsers, in 9/85 non-responders, and in no long-term responders. Overall, 9 episodes of severe events occurred in 20% of cirrhotics and in 0.6% of chronic hepatitis, all non-responders.

Conclusions: Long-term response interrupts the progression to cirrhosis and reduces the incidence of severe complications. Multivariate analysis revealed that "baseline diagnosis of cirrhosis" was the only independent factor predictive of an unfavourable outcome of chronic HCV-related liver disease.