PRETREATMENT VIRAL LOAD AND RESPONSE TO PROLONGED INTERFERON-ALPHA COURSE FOR CHRONIC HEPATITIS-C

Background/Aims: We investigated the clinical benefit of long-term interferon therapy in chronic hepatitis C in relation to the pretreatment viral load and genotypes. Methods: Chronic hepatitis C patients were randomly assigned to receive 28-week (n=45) or 52-week (n=43) courses of interferon-alpha. The responses were correlated with pretreatment viremic levels assessed by a branched DNA assay and genotypes. Results: After the 28-week interferon-alpha course, sustained aminotransferase normalization showed correlation with a lower initial viral load. The normalization was achieved by 78% (7/9) of the low viremic (branched DNA-negative) patients, but only 22% (8/36) of the highly viremic (branched DNA-positive) patients (p<0.01), Treatment with the 52-week interferon-alpha course increased the incidence of a sustained response in highly viremic patients and led to a decrease in relapse after therapy withdrawal (p<0.05). Thus, 75% (6/8) of the low viremic patients and 49% (17/35) of the highly viremic patients showed a sustained response. The data further showed that frequent sustained responses in patients with genotypes III and IV were associated with a low initial viral load. Conclusions: These findings suggest that although the pretreatment viral load is an important virological factor for predicting responses to interferon in chronic hepatitis C, relapse in highly viremic patients may be prevented by long-term therapy.