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Pilot Study: Interferon- Effective for Acute Hepatitis C

Fifty percent to 84 percent of people asymptomatically infected with hepatitis C (HCV) develop chronic infection that may be complicated by the development of cirrhosis and liver failure. Further, even with prolonged combination therapy, eradicating chronic infection has been problematic. An industry-sponsored, multicenter study from Germany, published early by the New England Journal of Medicine, now provides compelling data that treatment begun soon after HCV infection may be highly effective.

Forty-four patients recently infected with hepatitis C were enrolled in a prospective trial of daily subcutaneous interferon- treatment for 4 weeks, followed by subcutaneous interferon- 3 times weekly for 20 weeks. The mean time from infection until start of treatment was 89 days (range, 30 to 112). Nine patients had acquired infection by intravenous drug use, 14 by needlestick injury, 7 by surgical procedures, and 10 by sexual contact. Twenty-seven were infected with HCV genotype 1, and 12 with HCV genotype 2 or 3. All 44 patients developed undetectable HCV levels ( < 600 copies/mL) during treatment, and their levels remained undetectable 24 weeks after treatment was completed in 42 of the 43 patients who had reached that endpoint. One patient discontinued treatment at 12 weeks because of hair loss and influenza-like illness; otherwise, treatment appeared to be well tolerated, aside from expected thrombocytopenia and leukopenia.

Comment: This was not a controlled trial, and dose-ranging analysis was not performed. However, the fact that clearance of viremia was sustained in 98 percent of subjects is a striking alteration of the natural history of hepatitis C disease. Additional work is needed to define the durability of this response and the effectiveness of differing regimens and interferon preparations, alone or combined with ribavirin, in this setting.

— RE Ellison

Published in Journal Watch Infectious Diseases October 19, 2001

Citation(s):

Jaeckel E et al. Treatment of acute hepatitis C with interferon alfa 2-b. N Engl J Med 2001 Nov 15 345 1452-1457.

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