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Interferon-alpha and ribavirin tretment in patients with chronic hepatitis C and normal serum alanine aminotranferase values

HCV-RNA positive patients with normal serum ALT levels represent around one third of the HCV carriers in the general population. Although their liver biopsy is rarely completely normal and variable degrees of histological changes are found, with mild chronic hepatitis being the most common finding, antiviral treatment is generally not recommended, since progressive liver disease is unlikely as long as the ALT remains normal, and the benefit of the treatment is still doubtful. Aim of the study was to evaluate the efficacy of combination therapy with interferon-alpha (IFN-alpha) and ribavirin in patients with chronic hepatitis C and normal ALT values. In the retrospective study 12 HCV-RNA positive patients (7 males and 5 females, mean age 38.1 years), treated between 1998 and 2001, with normal or near-normal ALT values on three consecutive occasions and histologically mild disease were identified. During the induction period of 4 weeks they received 5 MU IFN-alpha 2b and ribavirin 1000 mg daily. Following 44 weeks they received 3 MU IFN-alpha 2b thrice weekly with ribavirin 1000 mg daily. Serum HCV-RNA level was tested every three months during the treatment, at the end of the therapy (end-of-treatment virological response) and 6 months afterwards (sustained virological response). Seven out of 12 patients (58%) were HCV-RNA negative at the end of the therapy and 5 of 12 (42%) showed sustained virological response. No significant elevation of aminotranferase values was detected during the therapy. Patients with mild chronic hepatitis C and normal ALT levels have good response to interferon and ribavirin combination therapy, similar to those with elevated ALT levels. As long as the natural history and long-term outcome of these patients are not completely known, this might be the beneficial treatment option.

chronic hepatitis C; normal alanine aminotransferase values; liver biopsy; antiviral treatment; combination therapy; interferon-alpha; ribavirin; results

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