Author:
Laurence Chone, et al
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Date Posted: Wed, October 03 2001, 10:37:47 PDT
In reply to:
Teresa Hanbey
's message, "Treatment of acute cases of hepatitis C: Marketing or science?" on Tue, October 02 2001, 8:13:25 PDT
First presented as a poster abstract at Digestive Disease Week 2001,May 20-23, 2001, Atlanta, Georgia.
EARLY TREATMENT OF ACUTE HEPATITIS C INFECTION WITH MONOTHERAPY INTERFERON ALFA IS EFFECTIVE TO PREVENT DEVELOPMENT OF CHRONIC HEPATITIS
Laurence Chone, Jean-Pierre Bronowicki, Helene Barraud, Jerome Watelet, Herve Hudziak, Patrice Wolff, Marc-Andre Bigard, CHU Nancy-Brabois, Nancy France
Acute hepatitis C is often asymptomatic but has a great propensity to become chronic.
Available data seem to indicate that Interferon may reduce the rate of chronicity. From 1990 until October 2000, 1605 patients with hepatitis C infection were sent in our unit because of HCV infection. Among them, 18 (1.1%) had symptomatic acute HCV hepatitis. Acute infection was defined as a period of less than 4 months after time of infection.
The mean age of patients was 24.5 years and 50% were female. Fifteen patients (83%) were infected by intravenous drug abuse, one (6%) patient after tattooing and in 2 patients (11%) the mode remained unclear.
Mean viral load at inclusion was 234 600 UI/ml (Cobas Amplicor HCV Monitor 2.0). Eleven (61%) patients were icteric with a mean bilirubin of 145 mg/L. Mean ALT was 1080 UI/L (range 172-2120).
Fourteen patients (77%) were treated with 3 MU Interferon alfa s.c. tiw for 6 months. One patient became spontaneously HCV-RNA negative before treatment and four months after contamination. Three patients were lost of view.
Therapy was initiated medium time of 51 days after acute infection. Among treated patients, 57% were HCV-RNA negative with normal transaminases after one month.
All patients HCV-RNA positive after 8 weeks of treatment remained non-responders during the treatment. At the end of the treatment, 10 patients (71%) were responders (HCV-RNA negative and normal transaminases).
Among the responder patients, 60% had a mean follow up period of 17 months, and all of them had sustained response. The others started intravenous drug abuse again and were lost of sight.
Conclusions: Early therapy of acute HCV infection with interferon alfa prevents development of chronic infection in 71% of patients. Response became soon (after one month in most of cases) and was sustained in all patients who accepted follow up. But to keep in view this patients, often active intravenous drug users, is the great challenge.
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