***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: Recurrent hepatitis C infection is an important cause of progressive fibrosis , cirrhosis , and graft loss following orthotopic liver transplantation . Treatment for posttransplant recurrence of hepatitis C with interferon-based therapy is difficult but results in loss of detectable virus in up to 30 % of patients . However , the durability of viral clearance and the associated histologic response in this setting is unknown . The aim of this study was to determine whether viral loss in response to antiviral therapy is durable and associated with improvement in liver histology .  All liver transplant recipients who received interferon-based treatment for recurrent hepatitis C virus ( HCV ) at the University of Florida from 1991 to 2002 were included in this study . Patients who lost detectable HCV after treatment with interferon alone or in combination with ribavirin  were followed to assess the durability of viral response and its impact on liver histology .  One hundred nineteen transplant recipients were treated with interferon or combination therapy .  Twenty-nine ( 20 men , 9 women ; mean age , 54 yrs [ range , 42 - 74 yrs ] ) lost detectable HCV RNA and remained virus negative for at least 6 months after discontinuing therapy ( sustained viral response[SVR ] ) . The mean follow-up after discontinuing therapy was 24.7 months ( range , 6 - 70 mos ) . Our study cohort included one patient with SVR following interferon monotherapy and 28 patients with SVR following combination therapy with interferon plus ribavirin .  All patients remained HCV RNA negative ( assessed by polymerase chain reaction or branched-DNA assay ) during follow-up of up to 5 years . Liver histology assessed 2 years after treatment showed less inflammation compared with before treatment in 50 % and showed no change in 38 % . By 3 to 5 years post-treatment ( n = 15 recipients ) , inflammation was reduced in 60 % and remained unchanged in 33 % . Fibrosis stage at 2 years improved by > or = 1 stage in 27 % , remained unchanged in 38 % , and worsened in 35 % despite viral clearance . At 3 to 5 years , the fibrosis stage had improved in 67 % , remained unchanged in 13 % , and worsened in 20 % . Both grade of inflammation and fibrosis stage improved by 3 to 5 years posttreatment compared with baseline histology ( p < 0.05 ) . In conclusion , loss of HCV after treatment of recurrent chronic hepatitis C with interferon and ribavirin is durable , and the durability of the SVR is associated with improvement in hepatic inflammation and regression of fibrosis The aims of this pilot study were to evaluate the safety and efficacy of interferon-alpha 2b for treatment of hepatitis C virus infection in liver transplant recipients , to monitor changes in hepatitis C virus RNA levels with treatment and to determine pretreatment parameters predictive of a complete response . Eighteen patients with documented hepatitis C virus viremia and histological evidence of hepatitis after liver transplantation received 3 million units of alpha interferon three times weekly for at least 4 mo . Pretreatment serum aminotransferase levels were at least 1.5 times the upper limit of normal and no patient had concomitant hepatitis B virus infection . Response to therapy was defined as normalization of both aspartate and alanine aminotransferase at the end of treatment . Five patients ( 28 % ) had a complete response , whereas 13 ( 72 % ) had persistent elevation of one or both aminotransferases ( nonresponders ) . At the end of therapy , hepatitis C virus RNA levels were reduced in both responders and nonresponders ( p = 0.043 and 0.039 , respectively by Wilcoxon signed rank test ) . After cessation of treatment , aminotransferases remained normal in four of five responders but serum hepatitis C virus RNA levels returned to pretreatment levels in responders and nonresponders . There was no significant change in histological score with therapy . Responders were more likely than nonresponders to have low pretreatment hepatitis C virus RNA levels and low serum bilirubin ( p = 0.0004 and 0.0077 , respectively ) . Responders tended to have a prolonged interval between transplantation and initiation of therapy ( p = 0.10 by rank logistic regression analysis ) . Side effects result ed in early cessation of therapy in two patients and dose reduction in six . ( ABSTRACT TRUNCATED AT 250 WORDS Background . Hepatitis C virus ( HCV ) recurrence after orthotopic liver transplantation ( OLT ) is universal . We aim ed to evaluate the efficacy and safety of pegylated interferon ( PEG-IFN ) and ribavirin ( RIB ) in the treatment of post-OLT HCV recurrence . Methods . Thirty-seven patients with recurrent HCV after OLT were screened and began treatment . Nineteen patients have completed therapy .  PEG-IFN was started at a dose of 0.5 & mgr;g/kg per week and titrated toward a maximum dose of 1.5 & mgr;g/kg per week . RIB was started at a dose of 400 mg per day and titrated toward a maximum of 1000 mg per day , as tolerated . Therapy continued for 1 year after HCV replication was undetectable by reverse transcriptase-polymerase chain reaction and was discontinued if there was no virologic clearance at 48 weeks . Results . Twelve patients ( 63 % ) completed the combination regimen . Therapy was discontinued in seven ( 37 % ) patients . Seven patients ( 37 % ) had undetectable viral load at the end of treatment . Of those , five patients ( 26 % ) had sustained viral response 6 months after discontinuation of therapy . Five patients ( 26 % ) had no virologic response . Necro-inflammatory score declined from 5.22 to 2.89 ( P = 0.05 ) in nonresponders versus 6.8 to 2.6 ( P < 0.01 ) in responders . Fibrosis stage did not change in either group . Genotype 1-infected patients had a lower likelihood of attaining end of treatment or sustained viral response ( P < 0.05 for both ) . Conclusions . Post-OLT HCV recurrence can be safely treated with PEG-IFN and RIB .  Bone marrow toxicity , depression , and rejection are limiting factors that require aggressive management . There was short-term histologic benefit to the use of this regimen , even in those patients without viral clearance BACKGROUND / AIMS After liver transplantation ( LT ) infection of the graft with the hepatitis C virus ( HCV ) is almost universal and chronic hepatitis and cirrhosis develop in a significant proportion of patients . One of the possible strategies to prevent HCV infection recurrence is to eradicate HCV before LT . METHODS We evaluated the efficacy and safety of antiviral therapy to prevent HCV recurrence in 30 HCV-cirrhotic patients awaiting LT . At the time of inclusion 15 patients were Child-Pugh A and 15 Child-Pugh B/C. The infecting genotype was 1b in 25 patients . Treatment with interferon alpha-2b 3 MU/day and ribavirin 800 mg/day was initiated when the expected time for LT was less than 4 months and continued until LT . The median duration of treatment was 12 weeks . RESULTS Nine patients ( 30 % ) achieved a virological response and 21 did not respond to therapy . In nine ( 43 % ) of the 21 non-responders viral load decreased > or = 2 log10 during treatment . A viral load decrease > or = 2 log10 at week 4 of treatment was the strongest predictor of virological response . All nine virological responders have already undergone LT ; six patients remain free of infection after a median follow-up of 46 weeks and HCV infection recurred in three patients after LT . In one of these patients HCV-RNA was still detectable in the explanted liver . Side effects were frequent and dose reduction was necessary in 19 ( 63 % ) of the 30 patients ; no patient died while on therapy . CONCLUSIONS Our data support the utilization of antiviral therapy in HCV-infected patients awaiting LT as one of the strategies to prevent hepatitis C recurrence after transplantation Recurrent hepatitis C virus ( HCV ) infection is an important cause of fibrosis and cirrhosis after liver transplantation ( LT ) , with histological recurrence developing in at least 50 % of patients within the first year . The aim of this study is to assess the safety and efficacy of interferon alfa-2b plus ribavirin in treating histological  recurrent HCV  after LT . Since 1998 , patients with HCV with significant histological recurrence ( fibrosis > /= 3 and /or histological activity index > /= 5 ) or progressive cholestatic disease after LT were treated with interferon alfa-2b ( 3 million units subcutaneously three times weekly ) plus ribavirin ( 800 to 1,000 mg/d ) for 12 months . Immunosuppression was tapered to cyclosporine/FK506 monotherapy . HCV RNA was assessed at entry , week 24 , end of treatment , and 6 months after therapy . The primary end point was loss of HCV RNA 6 months after therapy , whereas the secondary end point was histological response . Fifty-four patients met criteria for treatment and have completed follow-up . Patients were mainly men ( 71 % men ; mean age , 51 + /- 5 years ) with genotype 1 infection ( 88 % ) and high viral load ( mean HCV RNA , 38 + /- 9 mEq/mL ) . Dose modification was required in 72 % of patients because of cytopenia or side effects . Intent-to-treat analysis showed that serum HCV RNA was undetectable in 19 patients ( 35 % ) week 24 , 21 patients ( 38 % ) week 48 , and 16 patients ( 30 % ) at the 6-month follow-up . Paired liver biopsy results ( before and within 6 months after treatment ) were available for 35 patients . Patients who achieved viral eradication had no significant progression of fibrosis after 1 year of therapy . In summary , combination therapy is a reasonable antiviral option for recurrent HCV infection for established post-LT hepatitis and appears to prevent histological progression of disease if viral eradication is successful BACKGROUND In a r and omized , controlled trial , we sought to determine whether prophylaxis with interferon-alpha for 6 months had an impact on rate , severity , and timing of onset of recurrent hepatitis C virus ( HCV ) hepatitis in liver transplant recipients and to assess whether interferon use was associated with rejection in liver transplant recipients . METHODS Twenty-four consecutive liver transplant recipients with HCV were r and omized after transplantation to receive either interferon-alpha ( 3 million U three times weekly ) for 6 months or no prophylaxis ; median follow-up was 874 days . RESULTS Recurrent HCV hepatitis ( histopathologically proven ) developed in 50 % ( 6 of 12 ) of the interferon-alpha patients versus 42 % ( 5 of 12 ) of the control patients ( P = NS ) . Severity of recurrence ( as assessed by Knodell score on liver biopsies ) also did not differ between the two groups ( mean 4.0 for interferon-alpha patients versus 3.5 for control patients , P = NS ) . Interferon-alpha , however , significantly delayed the timing of occurrence of HCV hepatitis ; recurrent HCV hepatitis developed a median of 408 days after transplant in the interferon-alpha group versus 193 days in the control group ( P=0.05 ) . No difference in graft or patient survival was demonstrated in the two groups . Rejection episodes , treated with corticosteroids , occurred in 50 % ( 6 of 12 ) of patients in the interferon-alpha group versus 42 % ( 5 of 12 ) in the control group ( P = NS ) . Corticosteroid resistant rejection ( requiring OKT3 ) occurred in only one study patient ( in the control group ) . CONCLUSIONS Interferon-alpha in liver transplant recipients for 6 months delayed the occurrence of HCV hepatitis , but did not decrease the incidence nor the severity of HCV hepatitis after transplantation . Interferon-alpha use was not associated with a higher incidence of rejection compared with the control patients BACKGROUND AND AIMS Hepatitis C virus ( HCV ) reinfection after liver transplantation is frequent and leads to chronic hepatitis and cirrhosis . The use of antiviral therapy in this situation remains controversial . This study aim ed to assess the safety and efficacy of interferon alfa-2b plus ribavirin for recurrent hepatitis C following liver transplantation . METHODS Transplant recipients with recurrent chronic hepatitis C were r and omized to receive either no treatment or therapy with interferon alfa-2b ( 3 MU 3 times a week ) plus 1000 - 1200 mg/day ribavirin for 1 year . Patients were followed up for 6 months after the end of treatment . The primary end point was loss of HCV RNA 6 months after the end of treatment . RESULTS Fifty-two patients were r and omized ( treatment , 28 ; placebo , 24 ) . Six 
    Output:
    
Even the best antiviral therapy ( pegylated interferon/ribavirin ) is neither easily used nor reasonably effective .