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Interferon alfa in the treatment of chronic viral hepatitis B & C

  [ 38 votes ]   [ Discuss This Article ]
By Woo MH, Burnakis TG • • March 3, 1997

OBJECTIVE: To review the indications, efficacy, and toxicity
of interferon alfa in the treatment of chronic hepatitis B and
DATA SOURCES: English-language literature pertaining to
chronic hepatitis B and C and their management with
interferon reported between 1980 and June 1995 was identified
through computer searches using MEDLINE and through extensive
searching of bibliographies and identified articles.
SYNTHESIS: Two major causes of chronic hepatitis are hepatitis
B virus and hepatitis C virus (HBV and HCV). Worldwide, HBV
infection is a major cause of cirrhosis and hepatocellular
carcinoma, but in the US it is mainly a disease of high-risk
groups. In the US, and particularly the southern portion, HCV
is more common. Like HBV, HCV also may cause cirrhosis and
hepatocellular carcinoma. Except for interferon therapy, the
ability to effectively treat chronic hepatitis is limited.
Interferon has antiviral, antiproliferative, and
immunomodulatory activity. This agent is indicated in
patients who have histologic evidence of chronic hepatitis
and ongoing viral replication. Thirty percent to 40% of
patients with HBV achieve loss of serum HBV e antigen and HBV
DNA after treatment with interferon alfa 5 million units/d or
10 million units three times weekly for 16 weeks. Fifty
percent of patients with chronic HCV respond to interferon 3
million units three times weekly for 6 months, but half of
these relapse within the next 6 months. Prolonged use (18
months) may provide longer term responses in HCV. Adverse
effects are common, often dose-dependent, and usually
transient. A flu-like syndrome occurs early in the treatment,
but fatigue is the most common adverse effect and persists
throughout therapy. Long-term interferon treatment has not
been extensively evaluated and the impact on survival rates is
not known.
CONCLUSIONS: Interferon is the only agent to have
shown a consistent therapeutic effect on chronic hepatitis.
Response of HBV to interferon is usually sustained, while a
recurrence of HCV occurs in 50% of those who initially
respond. Despite the benefits of interferon, its adverse
effects and impact on hepatitis must be considered before
treatment can be freely advocated.

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