NEW YORK (Reuters Health) Nov 12 - Sustained virological responses to interferon therapy for hepatitis C virus (HCV) infection persist for as long as 12 years, according to a report in the November Journal of Medical Virology.

Previous studies have shown persistent virological and biochemical remission for up to 5 years after successful treatment with interferon, the authors explain, but HCV eradication from the liver has not been well validated in longer follow-up.

Dr. Natsuko Tsuda from Osaka National Hospital, Osaka, Japan and colleagues monitored 38 sustained virological responders and 37 biochemical responders for 4.4 years to 12 years interferon therapy for HCV.

All sustained virological responders remained persistently negative for serum HCV RNA, with normal ALT levels, during the entire follow-up period, the authors report, whereas all biochemical responders had persistent HCV viremia and nearly half (46%) experienced biochemical flare-ups.

Four sustained virological responders (but no biochemical responders) developed hepatocellular carcinoma (from 6 months to 5.5 years after treatment), the report indicates. All four patients had cirrhosis or bridging fibrosis before treatment.

HCV RNA strands were not found in biopsies from 15 sustained virological responders performed 5.9 to 12.5 years after pre-treatment biopsies, the researchers note, but all but one of 15 biochemical responders who had repeat biopsies had both positive and negative HCV RNA strands in the liver.

Hepatitis B virus DNA was not found in liver biopsies, irrespective of HCV clearance, the results indicate.

All histological measures improved significantly in the sustained virological responders, whereas only piecemeal necrosis and focal necrosis improved in the biochemical responders. In both groups, evidence of at least mild inflammation remained in the post-treatment biopsies.

"Collectively, these findings suggest that HCV seroclearance at 6 months after interferon therapy withdrawal would usually imply virological cure," the authors conclude. "Although further studies with a larger number of patients are necessary, control of biochemical disease activity to near-normal levels may also confer favorable long-term histological outcomes."

J Med Virol 2004;74:406-413.

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