Our findings provide evidence that a cardiac surgeon with chronic hepatitis C may have transmitted HCV to five of his patients during open-heart surgery.

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Pretreatment variables that could predict the response of chronic hepatitis C to interferon alfa treatment have not been fully assessed. Eighteen baseline variables were evaluated in a series of 100 consecutive patients treated with a 12 month course of interferon alfa. For the purposes of this study, response was defined as the return to normal of aminotransferase activities before the third month of treatment.Seventy per cent of the patients responded to treatment. Six variables were associated with an increased likelihood of response assessed by univariate analysis. With stepwise multiple regression analysis assessment, however, only three variables remained independently predictive of response: low y glutamyltransferase (yGT) activities (p<0.001), absence of obesity (p=0.005), and absence of cirrhosis (p=0-01). The response rate in patients with yGT activities <066 iikat/l (n=55) was 78% and 60% in patients with values >066 ikat/l (n=45) (p=.0048). Response was attained in 75% of non-obese patients (n=80), compared with only 50% of obese patients (n=20) (p=003). Finally, 80% of patients without cirrhosis (n=76) responded, while among those with cirrhosis (n=24) the response rate was only 37% (p<0001). All 23 patients without cirrhosis, <40 years old, and with yGT activities <0-66 tkat/l responded to treatment, while only 28-5% of 14 patients with cirrhosis, >40 years old, and with yGT activities >0 66 pkat/l responded to interferon affa (p<0-001).Those findings may be useful when evaluating interferon alfa trials and it is suggested that this treatment should be applied early in the course of chronic hepatitis C.

For the 30-50% of patients with chronic hepatitis C who do not respond to a-interferon therapy there is no alternative treatment. Some previously untreated patients have shown a biochemical response to ribavirin, but the antiviral effects of this substance on a-interferon-resistant cases is largely unknown. Twelve patients with chronic hepatitis C who had not responded to a 6-12 month course of a-interferon were included in this study. Oral ribavirin was administered at a dose of 16 mg/kg per day for 6 or 9 months. Aminotransferase levels had not significantly changed during interferon therapy but decreased significantly during ribavirin treatment (mean alanine aminotransferase at baseline, 102 ± 18 IU/I vs. 55 ± 14 IU/I at 6 months; P = 0.0001). Aminotransferase levels became normal in 6 cases (50'V,,), significantly decreased in 3 patients (25'Vo), and did not significantly change in the remaining 3 cases (25'V,,). All patients with normalized aminotransferase values relapsed after ribavirin was discontinued and aminotransferase activity returned to pretreatment levels. Before therapy serum hepatitis C virus RNA was detected by polymerase chain reaction in 10 cases. None of them had cleared viral RNA when tested following 3, 6 and 9 months of ribavirin therapy. Side-effects were mild and reversible. In conclusion, about half of the patients with chronic hepatitis C who are unresponsive to a-interferon show a clear-cut biochemical response after 6-9 months of ribavirin administration. However, ribavirin does not clear circulating hepatitis C virus RNA and relapses occur after withdrawal. Therefore, since ribavirin alone does not appear to suppress viral replication, despite its biochemical effect, further studies should be made in combination with other antiviral substances.

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