ASSOCIATION OF RESPONSE TO COMBINED INTERFERON ALPHA- 2b AND RIBAVIRIN THERAPY IN PATIENTS OF CHRONIC HEPATITIS C WITH SERUM ALANINE AMINOTRANSFERASE LEVELS AND SEVERITY OF THE DISEASE ON LIVER BIOPSY
AbstractBackground: Raised serum alanine aminotransferase (serum ALT) levels indicate active liver diseasewhile liver biopsy has been considered the ‘gold standard’ for assessing the severity of disease inpatients of chronic Hepatitis C. The response of these patients to standard treatment regimen ofinterferon (INF)-alpha- 2b and ribavirin for 24 weeks have been studied. Objective: The objective ofthis study was to evaluate the association of response to combined INF alpha-2b and ribavirin therapyin patients of chronic hepatitis C with serum ALT levels and severity of the disease on liver biopsy.Methods: This quasi experimental study was conducted in Department of Physiology at Army MedicalCollege and Military Hospital, Rawalpindi from January 2006 to February 2007. One hundred andseven diagnosed non cirrhotic chronic hepatitis C patients were studied. Prior to the commencement oftreatment, qualitative assay of Hepatitis C Virus (HCV) Ribonucleic Acid (RNA) was done byPolymerase chain reaction (PCR). Knodell Histopathological Index (HPI) was determined on liverbiopsy. The standard treatment of INF-alpha-2b, 3 million units 3 times a week subcutaneous, andRibavirin 800–1200 mg per day was given for 24 weeks. Serum ALT levels were determined beforethe start of treatment and later at weeks 12 and 24. Qualitative assay of HCV RNA was done by PCRat the end of treatment to determine the response to treatment. Statistical analysis was done on SPSS 15.Results: Out of 107 patients of chronic hepatitis C, 92 (69 males, 23 females) patients (84%) respondedto INF-alpha-2b and ribavirin therapy and revealed negative qualitative assay of HCV RNA by PCR atthe end of 24 weeks of treatment while serum ALT levels were normal in 88% of patients at 12 weeksand in 97% at the end of 24 weeks of treatment. Knodell HPI revealed mild, moderate and severedisease in 47.7%, 39.9% and 13.1% of patients respectively. No association was established betweenresponse to treatment and severity of the disease on liver biopsy (p<0.11) and serum ALT levels(p=0.09). Conclusion: Response to Interferon alpha-2b and ribavirin therapy in patients of chronichepatitis C is not associated with the levels of serum ALT and the severity of the illness graded on liverbiopsy.Keywords: Chronic hepatitis C, interferon, liver biopsy, serum alanine aminotransferase
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