Patients with well-documented chronic hepatitis C are being evaluated to determine the long-term natural history and evaluate therapies of this common form of chronic liver disease. Previous studies have shown that alpha interferon therapy has a short-term beneficial effect in approximately 50 per cent of patients. This response is sustained in approximately 10-15 per cent after stopping interferon. A randomized, placebo-controlled trial of ribavirin showed that a 1 year course of this nucleoside analogue is associated with significant improvement in serum aminotransferase activities and in hepatic lobular necrosis despite unchanged serum levels of HCV RNA. Continous ribavirin therapy for up to 2 years demonstrated the practicality of long term supressive therapy in this disease. A higher sustained response rate occurs with the combination of interferon and Ribavirin. A controlled trial of long term ribavirin immunotherapy is now underway; patients who do not respond to a standard 6-month course of interferon and ribavirin and treated with either ribavirin or placebo immunotherapy and assessed for histologic improvement. Sixty patients have enrolled in this study. The natural history of hepatitis C is evaluated in a study in which patients are monitored for biochemical and virologic tests and underwent repeat liver biopsies after 5 years. Immunological and virological assessment of the serum and liver tissue is focused on elucidating the pathogenesis of disease and the determinants of recovery. - Antiviral/Interferon/Ribavirin/Combination Therapy - Human Subjects
