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

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OBJECTIVE: To review the indications, efficacy, and toxicity

of interferon alfa in the treatment of chronic hepatitis B and

C.

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.

DATA

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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