Epatite acuta da HCV acquisita in comunita: Storia naturale e dati preliminari sul trattamento con interferone dei pazienti che hanno cronicizzato

Twenty consecutive patients (pts) with acute community acquired hepatitis C observed between 1991 and 1996, were enrolled in a prospective study to evaluate the natural course and the efficacy of interferon in pts who progressed to chronic hepatitis. Pts were followed for a mean of 40.1 months (range 12-72). Diagnosis of acute hepatitis was based on seroconversion to anti-HCV in 13 pts (65%). The HCV transmission modality was iv drug abuse in 9 pts (45%). 11 pts (55%) evolved from acute to chronic hepatitis: they were significantly younger and had a lower peak of bilirubin. In pts with self-limiting hepatitis ALT levels became normal between 1 and 3 mouth and 8/9 of them were HCV-RNA negative at month 2 (p=0.005 vs chronic pts). 7 pts who progressed to chronic hepatitis were underwent liver biopsies within 19 months from diagnosis of acute hepatitis: mean Ishak HAI score was 6.3. 6/7 pts treated with interferon completed a period of 12 months of follow-up: 66.6% were long term responders. In conclusion pts with acute community acquired hepatitis C frequently fail to clear the virus. HCV-RNA negative at month 2 was predictive of self-limiting course. IFN treatment in early chronic stage was effective in many pts.