We identified 82 consecutive patients, from 2 locations in Italy, who had an acute exacerbation of CHC from January 2005 through June 2010; we followed them up for a median period of 36 months. These cases were hepatitis C virus (HCV) RNA positive, hepatitis B surface antigen-negative, and had not received anti-HCV therapy. They were matched with 82 subjects with hepatitis C without reactivation for age, sex, and HCV genotype (controls). Sixty-nine cases and 73 controls were followed up for at least 2 years. Liver biopsy specimens had been taken from 23 cases and 31 controls¡ªonce before enrollment in the study and once during the follow-up period.
HCV genotype 2 was detected in 46.4 % of cases, and HCV genotype 1 was detected in 43.9 % . Among cases, the mean ALT level was 1063 ¡À 1038 IU/dL, and the mean total bilirubin level was 15.87 ¡À 7.15 mg/dL. A higher percentage of cases carried the interleukin-28B CC genotype than controls (40.2 % vs 24.4 % ; P < .05). Among cases, 43.5 % had a steady increase in ALT level (>2-fold baseline value); for 56.5 % of these patients, ALT levels returned to baseline values before the acute exacerbation of chronic hepatitis. Based on comparisons of biopsy specimens, 18 cases (78.3 % ) and 11 controls (35.5 % ) had increasing fibrosis, with Ishak scores increasing by more than 2 (P < .005); 14 cases (60.9 % ) and 3 controls (9.6 % ) had increases in necroinflammation of more than 2 points (P < .005). Thirty-two cases (46.4 % ) and 38 controls (52 % ) received treatment with pegylated interferon and ribavirin; a sustained virologic response was achieved in 26 cases (81.2 % ) and 23 controls (60.5 % ).
Although an acute exacerbation of chronic hepatitis is a serious medical condition, most patients achieve a sustained virologic response after treatment with pegylated interferon and ribavirin.