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Hepatitis C-Associated Fibrosis May Be Reversible

Treatment of hepatitis C infection can improve hepatic inflammation in some patients; however, fibrotic changes generally are presumed to be permanent. To test the validity of this assumption, Japanese investigators studied a retrospective cohort of 593 patients with hepatitis C who underwent 2 liver biopsies at least 1 year apart at 1 of 8 hospitals.

Of 487 patients treated with interferon for 2 to 6 months, 183 (38 percent) exhibited undetectable hepatitis C RNA levels more than 6 months after treatment ended (sustained virologic responders). Compared with histologic disease activity at the first biopsy, such activity was reduced at the second biopsy in 89 percent of sustained biologic responders, 32 percent of interferon-treated patients without sustained virologic responses, and 20 percent of untreated patients. Similarly, fibrosis was reduced in 59 percent of responders, 19 percent of nonresponders, and 5 percent of untreated patients.

Comment: These results demonstrate that regression of fibrosis can occur in hepatitis C patients, particularly in treatment responders. The relevance of these qualitative and quantitative histologic changes is unclear, although perhaps they will correlate with important clinical outcomes. The most disappointing finding, however, is consistent with other studies of hepatitis C: Most patients do not respond to treatment.

— R Saitz

Published in Journal Watch General Medicine April 14, 2000

Citation(s):

Shiratori Y et al. Histologic improvement of fibrosis in patients with hepatitis C who have sustained response to interferon therapy. Ann Intern Med 2000 Apr 4 132 517-524.

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