Retreatment of chronic hepatitis C with ribavirin followed by interferon

Background: α interferon has proven of limited efficacy in the treatment of chronic hepatitis C. Ribavirin has also been used to treat chronic hepatitis C, but nearly all patients show relapse of hepatitis after the drug is discontinued. Therefore, new therapeutic strategies based on the use of both of these drugs are currently under evaluation. Methods: Patients, 16, with chronic hepatitis C resistant to a previous 6 months course of lymphoblastoid α-interferon (eight interferon non-responders and eight interferon relapsers) received a 4 month course of ribavirin, 1000 mg/day, followed by a second course of the same schedule of lymphoblastoid α-interferon. Results: During the course of ribavirin, alanine aminotransferase levels decreased in all patients (range 12.7–83.9%, median 61.8%) and normalized in five earlier relapsers and in three earlier non-responders to α-interferon. In spite of the biochemical response to ribavirin, HCV-RNA remained detectable in the serum of all patients. At the end of α-interferon treatment, transaminase levels were abnormal in all earlier non-responders and normal in five earlier relapsers to α-interferon. HCV-RNA was cleared from serum in three of them. Six months, after the complete course of ribavirin and α-interferon, sustained normalization of aminotransferase levels associated with persistent clearance of HCV-RNA from serum was obtained in one of these patients. Another patient showed sustained biochemical response without clearance of HCV-RNA. In earlier relapsers to α-interferon, serum HCV-RNA levels decreased during treatment but returned to the pre-treatment values during the follow-up. The treatment could be carried out in all patients but one, who developed thrombocytopenia. Conclusions: This sequential treatment with ribavirin followed by α-interferon does not induce sustained response in previous non-responders to α-interferon alone and does not appear to significantly improve the results of retreatment with α-interferon alone in previous relapsers to treatment.