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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”


High-Dose Interferon Alpha-2b Prevents Chronic Hepatitis C Infection

WESTPORT, CT (Reuters Health) Nov 14 - Early treatment of acute hepatitis C
with a relatively short, high-dose regimen of interferon alpha-2b prevents
the development of chronic infection in most patients, German investigators
report in the New England Journal of Medicine for November 15.
Forty-four patients with acute hepatitis C were treated with 5 million U of
interferon alpha-2b SC daily for 4 weeks, followed by 5 million U three
times a week for an additional 20 weeks. Time from infection to the first
signs or symptoms of illness ranged from 15 to 105 days (mean 54 days),
while the time from infection until start of therapy was 30 to 112 days
(mean 89 days).
Dr. Michael P. Manns, of the Medizinische Hochschule Hannover, and members
of the German Acute Hepatitis C Therapy Group documented that the average
time required for Hepatitis C Virus RNA to become undetectable after treatment initiation was 3.2 weeks. All patients reached this goal during therapy.


All but nine patients had normal alanine aminotransferase levels by the end
of therapy. Those nine exhibited a mild elevation of not more than twice the
upper limit of the normal range. Although thrombocytopenia and leukopenia
developed in all patients, these abnormalities resolved after therapy ended.
Dr. Jay H. Hoofnagle, of the National Institute of Diabetes and Digestive
and Kidney Diseases in Bethesda, Maryland, notes in an editorial that the
recovery rate observed by Dr. Manns' team well exceeds the natural
spontaneous recovery rate of 15% to 30%. The rate is also higher than the
best rate observed for patients with chronic hepatitis C.
Still, Dr. Hoofnagle questions the value of initiating therapy immediately
in patients with acute infection, given the low rate of morbidity and
mortality during the first 2 decades of chronic liver disease. He suggests
that another strategy, delaying therapy to see if the infection resolves
spontaneously, may be feasible.


N Engl J Med 2001;345:1452-1457,1495-1497.