Rapid virological response as a predictor of sustained response in HCV-infected patients with persistently normal alanine aminotransferase levels: A multicenter study.

Rapid virological response (RVR) is now considered the strongest predictor of sustained virological response (SVR) in patients with HCV undergoing antiviral treatment, and thus, shorter antiviral treatment for these patients has been suggested. However, no data exist on the predictive value of RVR in HCV carriers with normal ALT values. A total of 137 patients with persistently normal ALT treated with peginterferon alfa 2a and ribavirin were studied. Fifteen patients dropped out early because of side effects, and in 10 patients with HCV-1 treatment was discontinued because of lack of early virological response (EVR). RVR was observed in 68% of the patients (42% patients with HCV-1, 90% HCV-2 and 64% HCV-3). An end-of-treatment response was observed in 86% of the patients (68% HCV-1, 100% HCV-2 and 91% HCV-3). SVR was maintained in 91 patients (46% HCV-1, 97% HCV-2 and 82% HCV-3). Overall, 92% patients with rapid response did obtain HCV eradication vs only 38% of those without rapid response. HCV-1 patients with baseline HCV RNA <400×10(3) IU/mL were more likely to achieve RVR and SVR than those with higher HCV RNA levels. We conclude that patients with genotype 1 and normal ALT who achieve HCV RNA negativity at week 4 may have a higher probability of eradicating their infection. Because of the concomitant favourable demographic and virological features often found in this particular subset of patients, the duration of therapy in these people might be shortened in the case of RVR. Persistently normal alanine aminotransferase levels patients with genotype 2 or 3 have a high chance of achieving SVR, so retesting of HCV RNA during treatment may have no additional practical value in these subjects.

Is interferon a useful treatment for virus C cirrhosis?

The authors have reviewed the recent literature on the usage of interferon alpha and beta with patients affected by liver cirrhosis caused by HCV. Broad wide surveys, consisting of ten trials, met the criteria for inclusion in the study. The following points were considered: the degree of complete response (transaminase normalization); complete follow-up response; viremia clearance. Interferon alpha was used in 9 cases out of 10, while interferon beta was used in one case only, with variable dosage and different time of administration, according to the different studies. A total of 539 patients affected by chronic hepatitis or cirrhosis were examined. 245 of them were affected by chronic cirrhosis: the response was complete in 65 patients out of 245 examined (26%), while 17 of 245 (7%) had a limited response. The clearance of viremia, in those studies where this value was reported, was noted in no more than 75% of the responders. The best results were achieved in those cases where it had been possible to use higher dosages of IFN (up to 6 MU x 3) and for a period of more than 12 months, without causing noteworthy side effects. The low percentage of patients with a limited response (7%) should not dissuade from using IFN. In accordance with significant recent reports, in several cases this therapy would lead to a slowing down of the histological progression of the disease and even to a decrease in the percentage of hepato-carcinoma developments, consequently resulting in a longer life for the patient and in less need of hospitalization. These results could justify the use of interferon even though it is a very expensive treatment.

[Mediastino-abdominal lipomatosis. Description of a case]. / Lipomatosi mediastino addominale. Descrizione di un caso.

The authors describe a case of mediastino-abdominal lipomatosis. The patient, who is 70 years old, was kept under observation, because of her recent state of illness. This state of illness was initially interpreted as angor attacks and a left ventricular failure. Only after the results of a CT examination showing a characteristic disproportion between the endothoracic-endoabdominal adipose tissue and the subcutaneous tissue, a correct interpretation was given. As a result the patient's state of illness was attributed to a compression of the adipose tissue growth in the abdominal and thoracic cavity. The etiology of mediastino-abdominal lipomatosis is still unknown. Therapy consists in removing the lipomas surgically when they cause a compression of the trachea and the upper vena cava.