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Interferon-α in Chronic Hepatitis C
- Savino Bruno, MD;
- Mauro Borzio, MD; and
- Pier Maria Battezzati, MD
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TO THE EDITOR:
Marcellin and colleagues' study [1] suggests that patients with chronic hepatitis C showing sustained response to interferon-α have a low risk for development of hepatocellular carcinoma. We are following a cohort of 23 long-term responders (5 with cirrhosis) who received interferon-α2a in a randomized clinical trial [2] and were observed for a mean (±SD) of 77 ± 20 months (range, 50 to 114 months) after discontinuation of treatment. Sustained response was defined as persistently normal alanine aminotransferase levels at monthly determinations during the first 12 months after discontinuation of interferon-α2a and every 3 months afterward. Hepatitis C virus (HCV) RNA was quantitatively and qualitatively measured by nested polymerase chain reaction (as described by Manzin and colleagues [3]) at the end of treatment and at 6-month intervals thereafter. Patients with cirrhosis underwent abdominal ultrasonography twice yearly. For all patients, liver histologic findings were available at baseline and 1 year after discontinuation of interferon-α2a therapy.
Hepatitis C virus RNA had become undetectable in both serum and liver tissue at the time of post-treatment liver biopsy in two patients with cirrhosis. These patients showed no biochemical or virologic relapse during further follow-up. However, in one male patient (63 years of age at entry; genotype 2a/c; negative for hepatitis B surface antigen; no history of alcohol abuse; histologic activity index score, 13 ± 4 at baseline and 7 ± 4 after treatment), an 18-mm focal lesion was detected by ultrasonography 54 months after discontinuation of interferon-α2a therapy. Intralesional histologic assessment confirmed the presence of hepatocellular carcinoma.
We conclude that hepatocellular carcinoma may occur in cirrhotic patients even when HCV RNA clearance and histologic improvement have been achieved. Efficacy of interferon-α2a therapy in preventing neoplastic evolution is far from being established in this population, and careful ultrasonographic monitoring aimed at early recognition of hepatocellular carcinoma should not be discarded.
Savino Bruno, MD
Mauro Borzio, MD
Pier Maria Battezzati, MD
School of Medicine Ospedale S. Paolo; 20142 Milan, Italy
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
