***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND & AIMS Liver fibrosis is an important prognostic factor in patients with hepatitis C. The effect of pegylated ( PEG ) interferon alone or its combination with ribavirin on fibrosis has not been established . METHODS We pooled individual data from 3010 naive patients with pretreatment and posttreatment biopsies from 4 r and omized trials . Ten different regimens combining st and ard interferon , PEG interferon , and ribavirin were compared . The impact of each regimen was estimated by the percentage of patients with at least 1 grade improvement in the necrosis and inflammation ( METAVIR score ) , the percentage of patients with at least 1 stage worsening in fibrosis METAVIR score , and by the fibrosis progression rate per year . RESULTS Necrosis and inflammation improvement ranged from 39 % ( interferon 24 weeks ) to 73 % ( optimized PEG 1.5 and ribavirin ; P < 0.001 ) . Fibrosis worsening ranges from 23 % ( interferon 24 weeks ) to 8 % ( optimized PEG 1.5 and ribavirin ; P < 0.001 ) . All regimens significantly reduced the fibrosis progression rates in comparison to rates before treatment . The reversal of cirrhosis was observed in 75 patients ( 49 % ) of 153 patients with baseline cirrhosis . Six factors were independently associated with the absence of significant fibrosis after treatment : baseline fibrosis stage ( odds ratio [ OR ] = 0.12 ; P < 0.0001 ) , sustained viral response ( OR = 0.36 ; P < 0.0001 ) , age < 40 years ( OR = 0.51 ; P < 0.001 ) , body mass index < 27 kg/m(2 ) ( OR = 0.65 ; P < 0.001 ) , no or minimal baseline activity ( OR = 0.70 ; P = 0.02 ) , and viral load < 3.5 millions copies per milliliter ( OR = 0.79 ; P = 0.03 ) . CONCLUSIONS PEG-interferon and ribavirin combination significantly reduces the rate of fibrosis progression in patients with hepatitis BACKGROUND & AIMS Chronic hepatitis C is both a virologic and fibrotic disease and complications can occur in patients with sustained virologic response ( SVR ) with residual fibrosis . Due to the limitations of repeated biopsies , no studies have assessed the dynamic of fibrosis before and after treatment . Using biopsy as reference , FibroTest ™ has been vali date d as a biomarker of fibrosis progression and regression , with similar prognostic values . The aim was to estimate the impact of SVR on the dynamic of fibrosis presumed by FibroTest ™ . METHODS In a prospect i ve cohort , the main end point was the 10-year regression rate of fibrosis , defined as a minimum 0.20 decrease in FibroTest ™ , equivalent to one METAVIR stage . RESULTS A total of 933 patients with both repeated FibroTest ™ and transient elastography were included . At 10 years , among the 415 patients with baseline advanced fibrosis , 49 % ( 95 % CI 33 - 64 % ) of the 108 SVR had a regression , which was greater than in the 219 non-responders [ 23 % ( 14 - 33 % ; p < 0.001 vs. SVR ) ] and not lower than in the 88 non-treated [ 45 % ( 10 - 80 % ; p = 0.39 vs. SVR ) ] patients . In all 171 SVR , cirrhosis regressed in 24/43 patients , but 15 new cirrhosis cases occurred out of 128 patients , that is only a net reduction of 5.3 % [ ( 24 - 15 ) = 9/171 ) ; ( 2.4 - 9.8 % ) ] . Four cases of primary liver cancer occurred in SVR [ 4.6 % ( 0 - 9.8 ) ] , and 13 in non-responders [ 5.6 % ( 1.5 - 9.8 ) ; p = 0.07 ] . CONCLUSIONS In patients with chronic hepatitis C , and as presumed by FibroTest ™ , virological cure was associated with slow regression of fibrosis 10years later , a disappointing 5 % decrease in cirrhosis cases , and a remaining 5 % risk of primary liver cancer BACKGROUND A sustained virological response ( SVR ) rate of 41 % has been achieved with interferon alfa-2b plus ribavirin therapy of chronic hepatitis C. In this r and omised trial , peginterferon alfa-2b plus ribavirin was compared with interferon alfa-2b plus ribavirin . METHODS 1530 patients with chronic hepatitis C were assigned interferon alfa-2b ( 3 MU subcutaneously three times per week ) plus ribavirin 1000 - 1200 mg/day orally , peginterferon alfa-2b 1.5 microg/kg each week plus 800 mg/day ribavirin , or peginterferon alfa-2b 1.5 microg/kg per week for 4 weeks then 0.5 microg/kg per week plus ribavirin 1000 - 1200 mg/day for 48 weeks . The primary endpoint was the SVR rate ( undetectable hepatitis C virus [ HCV ] RNA in serum at 24-week follow-up ) . Analyses were based on patients who received at least one dose of study medication . FINDINGS The SVR rate was significantly higher ( p=0.01 for both comparisons ) in the higher-dose peginterferon group ( 274/511 [ 54 % ] ) than in the lower-dose peginterferon ( 244/514 [ 47 % ] ) or interferon ( 235/505 [ 47 % ] ) groups . Among patients with HCV genotype 1 infection , the corresponding SVR rates were 42 % ( 145/348 ) , 34 % ( 118/349 ) , and 33 % ( 114/343 ) . The rate for patients with genotype 2 and 3 infections was about 80 % for all treatment groups . Secondary analyses identified bodyweight as an important predictor of SVR , prompting comparison of the interferon regimens after adjusting ribavirin for bodyweight ( mg/kg ) . Side-effect profiles were similar between the treatment groups . INTERPRETATION In patients with chronic hepatitis C , the most effective therapy is the combination of peginterferon alfa-2b 1.5 microg/kg per week plus ribavirin . The benefit is mostly achieved in patients with HCV genotype 1 infections Interferon and ribavirin decrease necroinflammation in chronic hepatitis C with or without virological clearance ; however , reversibility of fibrosis remains to be established . We evaluated the effect of combination therapy on virological and liver histopathological outcomes in 52 naïve patients and 79 patients unresponsive to interferon monotherapy with predominantly genotype 1 chronic hepatitis C. One hundred four patients completed interferon and ribavirin treatment after 24–48 weeks . Fifty-six paired liver biopsies ( mean biopsy interval 28 months ) were assessed by the Ishak score . Sustained virological responses were 37 % in naïve patients and 22 % in re-treated patients . In virological responders and nonresponders , fibrosis and necroinflammation scores decreased by −0.91 ( P = 0.04 ) and −0.5 ( P = 0.02 ) and by −2.8 ( P = 0.001 ) and −0.66 ( P = 0.06 ) , respectively . Interferon and ribavirin had greater benefit on fibrosis when associated with clearance of HCV RNA . Treatment strategies in virological nonresponders who show fibrosis regression should include consideration of maintenance therapy , if such treatment eventually proves to benefit histological outcomes BACKGROUND In phase 2 trials , telaprevir , a hepatitis C virus ( HCV ) genotype 1 protease inhibitor , in combination with peginterferon-ribavirin , as compared with peginterferon-ribavirin alone , has shown improved efficacy , with potential for shortening the duration of treatment in a majority of patients . METHODS In this international , phase 3 , r and omized , double-blind , placebo-controlled trial , we assigned 1088 patients with HCV genotype 1 infection who had not received previous treatment for the infection to one of three groups : a group receiving telaprevir combined with peginterferon alfa-2a and ribavirin for 12 weeks ( T12PR group ) , followed by peginterferon-ribavirin alone for 12 weeks if HCV RNA was undetectable at weeks 4 and 12 or for 36 weeks if HCV RNA was detectable at either time point ; a group receiving telaprevir with peginterferon-ribavirin for 8 weeks and placebo with peginterferon-ribavirin for 4 weeks ( T8PR group ) , followed by 12 or 36 weeks of peginterferon-ribavirin on the basis of the same HCV RNA criteria ; or a group receiving placebo with peginterferon-ribavirin for 12 weeks , followed by 36 weeks of peginterferon-ribavirin ( PR group ) . The primary end point was the proportion of patients who had undetectable plasma HCV RNA 24 weeks after the last planned dose of study treatment ( sustained virologic response ) . RESULTS Significantly more patients in the T12PR or T8PR group than in the PR group had a sustained virologic response ( 75 % and 69 % , respectively , vs. 44 % ; P<0.001 for the comparison of the T12PR or T8PR group with the PR group ) . A total of 58 % of the patients treated with telaprevir were eligible to receive 24 weeks of total treatment . Anemia , gastrointestinal side effects , and skin rashes occurred at a higher incidence among patients receiving telaprevir than among those receiving peginterferon-ribavirin alone . The overall rate of discontinuation of the treatment regimen owing to adverse events was 10 % in the T12PR and T8PR groups and 7 % in the PR group . CONCLUSIONS Telaprevir with peginterferon-ribavirin , as compared with peginterferon-ribavirin alone , was associated with significantly improved rates of sustained virologic response in patients with HCV genotype 1 infection who had not received previous treatment , with only 24 weeks of therapy administered in the majority of patients . ( Funded by Vertex Pharmaceuticals and Tibotec ; ADVANCE Clinical Trials.gov number , NCT00627926 . ) The prognosis of chronic hepatitis C virus ( HCV ) infection is still ill‐defined . The present study prospect ively evaluated mortality and complications in a large cohort of patients with chronic hepatitis C. The study included 838 anti‐HCV and HCV‐RNA – positive patients who were followed for 50.2 ± 26.9 months ( mean ± SD ; range , 6‐122 months ) in a prospect i ve protocol . During follow‐up , 62 patients died ( 31 from liver disease and 31 from other causes ) , and 12 patients needed liver transplantation . When compared with a matched general population , hepatitis C increased mortality mainly when cirrhosis was present and in patients who were less than 50 years old at study entry . During follow‐up , a further 30 patients developed nonlethal complications of cirrhosis . By multivariate regression , survival was decreased by cirrhosis , long disease duration , history of intravenous drug abuse , and excessive alcohol consumption , whereas interferon therapy improved survival . Alanine transaminase ( ALT ) , bilirubin , sex , and genotype had no effect on survival . The risk of hepatocellular carcinoma ( HCC ) ( n = 17 ) was increased by cirrhosis and to a lesser degree by long disease duration and high bilirubin , whereas interferon therapy , genotype , and other factors had no effect . Chronic hepatitis C is a disease with considerable mortality and morbidity when cirrhosis is present at diagnosis . Patients who acquire the infection early in life have a markedly increased mortality even when cirrhosis is absent at diagnosis . The age at diagnosis therefore should play a major role in therapeutic considerations . The present data also suggest that interferon therapy  has a long‐term clinical benefit , although it did not reduce the risk of liver cancer BACKGROUND / AIMS Data on hepatitis C virus ( HCV ) viral dynamics and on the effect of interferon in blocking virion production have suggested a rationale for daily administration of interferon in patients with chronic hepatitis C infection . We compared the efficacy and safety of daily interferon alfa-2b in combination with ribavirin with those of interferon alfa-2b three times a week alone or in combination with ribavirin . METHODS We r and omly assigned 321 patients with chronic hepatitis C to receive st and ard-dose interferon alfa-2b alone or in combination with 
    Output:
    
Conclusions : There could be a favorable characteristic of fibrosis regression in SVR patients .
However , residential fibrosis may remain an issue because of a non‐ignorable prevalence of fibrosis maintenance among these patients