alpha-Interferon treatment of chronic hepatitis C in young patients with homozygous beta-thalassemia.
BACKGROUND
Chronic infection with the hepatitis C virus (HCV) and iron overload are the main causes of chronic liver disease in subjects with homozygous beta-thalassemia (HBT). Iron overload can be counteracted by intensive chelation. alpha-interferon reduces viremia and necroinflammation in patients with chronic HCV hepatitis.


METHODS
To assess the effectiveness and safety of alpha 2b-Interferon (IFN), we enrolled in an open pilot trial of treatment 12 patients with HBT and biopsy-proven anti-HCV positive chronic hepatitis. IFN was given at a dose of 5 MU/m2 thrice weekly for 8 weeks, then 3 MU/m2 thrice weekly for 18 weeks. Patients were followed up to 24 months after stopping treatment when a second liver biopsy was performed in subjects with sustained response (normal ALT during follow-up).


RESULTS
Two patients discontinued IFN at 7 weeks because of haemolytic anemia and one after 8 weeks due to persistent fever. Among 9 subjects completing the protocol, 5 normalized ALT while on treatment and a further 2 within two months after stopping IFN. A sustained response was obtained altogether in 5 patients, since ALT relapsed in 2 responders. None of the 3 subjects who discontinued IFN and of the 2 patients who did not respond to treatment normalized ALT over a 24 months follow-up. Post-treatment liver histology in long-term responders showed a reduction of portal, periportal and lobular necroinflammation, while siderosis was essentially unchanged.


CONCLUSIONS
Although the pattern of response to IFN in HCV-infected subjects with HBT might differ from that of non-thalassemics, due to peculiar side effects and delayed response, the drug appears to be effective and deserves further investigation.
Di Marco
V
V
Istituto di Medicina Generale e Pneumologia, Università di Palermo, Italy.
Lo Iacono
O
O
Capra
M
M
Grutta
S
S
Ciaccio
C
C
Gerardi
C
C
Maggio
A
A
Renda
D
D
Almasio
P
P
Pisa
R
R
D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood; D002648:Child; D005260:Female; D006432:Hemochromatosis / Q000150:complications; D006526:Hepatitis C / Q000150:complications / Q000473:pathology / Q000628:therapy*; D006521:Hepatitis, Chronic / Q000150:complications / Q000473:pathology / Q000628:therapy*; D006720:Homozygote; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D011994:Recombinant Proteins; D012074:Remission Induction; D065227:Transfusion Reaction; D014766:Viremia / Q000150:complications / Q000628:therapy; D017086:beta-Thalassemia / Q000150:complications*
D007155:Immunologic Factors; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D000410:Alanine Transaminase