Interferons for viral hepatitis

Leukocyte interferon-alpha in the treatment of chronic hepatitis C in Finland

BACKGROUND

To evaluate the efficacy of leukocyte interferon in previously untreated patients with chronic hepatitis C, 97 patients were enrolled in a prospective study in Finland with a stepped-care management protocol.

METHODS

The treatment was initiated with 3 million units of interferon-alpha subcutaneously three times a week. At 3 months, if the serum alanine aminotransferase was still abnormal, the dose was doubled. If serum hepatitis C virus (HCV) RNA had turned negative at 6 months, the treatment was stopped; if it was still positive, treatment was continued for up to 12 months. All patients were followed up after treatment for 6 months. Altogether, 74 patients completed the treatment and follow-up periods.

RESULTS

Of all the originally enrolled patients 36% (35 of 97) achieved sustained virologic response, defined as HCV RNA negativity 6 months after the end of treatment. The commonest HCV genotype among these patients was 3a, and as many as 52% of such patients achieved sustained virologic response. Thirty-two per cent of the patients had HCV genotype 1a, 1b, or a mixture of these; a sustained response was achieved in only 6% of such patients but in 50% of patients with a non-1 genotype. Adverse effects caused treatment cessation for 10% of the patients and IFN dose reduction for 20%.

CONCLUSIONS

Monotherapy with human leukocyte interferon resulted in sustained virologic response in 36% of patients with chronic hepatitis C. In those infected with a HCV genotype other than 1, the sustained virologic response rate was 50%.

[Screening and early detection in blood transfusion: when are they indicated?]

Screening is proposed to allow an early intervention concerning a diseased individual, but its public health consequences are seldom considered. We propose criteria to judge whether a screening program can be associated to a benefit to patients or society. These criteria refer to the magnitude of disease, the characteristics of the pre-clinical stage, the availability of reliable and valid tests, the effectiveness and risk for all individuals, whether they are diseased or not, and acceptability to the health-care system and to individuals. We illustrate the application of these criteria to screening of human immunodeficiency virus among blood donors, hepatitis among recipients of labile blood products, and bacterial contaminations among febrile recipients. These criteria should be considered in decision analyses including alternatives to screening and all aspects of safety regarding patients and population.