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Improvement in Liver Fibrosis in Patients with Hepatitis C Who Respond to Interferon Treatment
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What is the problem and what is known about it so far?
When viewed under a microscope, liver tissue damaged by chronic infection with the hepatitis C virus shows inflammation. As the disease progresses, scarring (fibrosis) occurs. This scarring can eventually cause a condition called cirrhosis, which can lead to liver failure. In some patients, treatment with a drug called interferon eliminates the virus. Doctors can now measure the amount of virus in patients' blood. Patients who have no measurable amount of virus in their blood 6 months after interferon treatment are generally considered to have responded well to the drug. Preliminary studies suggest that patients who respond to interferon treatment have improvements in liver inflammation. It is not known, however, whether fibrosis also improves with interferon treatment.
Why did the researchers do this particular study?
To find out what happens to liver fibrosis in patients with chronic hepatitis C who respond to interferon treatment.
Who was studied?
The researchers studied 593 patients with chronic hepatitis C who happened to have at least two liver biopsies during 1987-1998. Liver biopsy involves inserting a needle through the skin into the liver to obtain samples of tissue. Of these patients, 487 had interferon treatment and 106 had no treatment.
How was the study done?
The researchers judged the amount of fibrosis on each liver biopsy sample. Next they compared what happened to the fibrosis between the first and the follow-up biopsies in patients that responded to interferon, in those who got interferon but did not respond, and in untreated patients.
What did the researchers find?
Of the 487 patients who got interferon, the virus was eliminated for at least 6 months in 183 but was not eliminated in the other 304. However, scarring improved in 108 of the 183 (59%) of the patients who responded to interferon. Fibrosis improved in only 57 of the 304 patients (19%) who got interferon but did not respond to it. Of the 106 patients who had no interferon treatment, the fibrosis improved in only 5 (5%).
What were the limitations of the study?
Patients were not selected randomly to receive interferon, so the patients who got interferon may have been less severely ill in the first place than those who did not get it. The time between biopsies varied from 1 to 10 years, which makes it hard to compare the results in different patients. In addition, improvements in fibrosis seen under the microscope do not necessarily mean that patients will feel better, have better liver function, or live longer than patients who have no improvements in fibrosis.
What are the implications of the study?
It appears that liver fibrosis can improve in some patients with chronic hepatitis C who show elimination of the virus 6 months after interferon treatment.
Article and Author Information
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The summary below is from the full report titled “Histologic Improvement of Fibrosis in Patients with Hepatitis C Who Have Sustained Response to Interferon Therapy.”. It is in the 4 April 2000 issue of Annals of Internal Medicine (volume 132, pages 517-524). The authors are Y. Shiratori, F. Imazeki, M. Moriyama, M. Yano, Y. Arakawa, O. Yokosuka, T. Kuroki, S. Nishiguchi, M. Sata, G. Yamada, S. Fujiyama, H. Yoshida, and M. Omata.
- Copyright ©2004 by the American College of Physicians
