Raised serum transaminases during treatment with pegylated interferon for chronic hepatitis C

Introduction: Serum transaminases rose significantly in 7 patients with chronic hepatitis C, genotypes 2 and 3, who were treated with pegylated interferon and ribavirin. Methods: 219 patients with chronic hepatitis C, genotypes 2 and 3, were treated between 2005 and 2011 following the same protocol. For the 7 patients presented in this paper, the initial liver screen revealed chronic hepatitis C infection only. The same liver screen was repeated following the transaminase rise during the treatment period and failed to reveal additional comorbidity. Results: 5 male and 2 female patients with chronic hepatitis C experienced a rise in serum transaminases after commencement on treatment with pegylated interferon and ribavirin. They all achieved rapid and end of treatment virological responses. 3 of the patients achieved sustained virological response and 4 relapsed. There was no evidence to suggest that steatosis, development of autoimmunity or intercurrent illness was the cause of the liver injury. In 3 out of 7 patients, the level of transaminases exhibited a downward trend after pegylated interferon was changed to non pegylated interferon. Additionally, it is evident that in those patients whose treatment was temporarily or permanently aborted, the rise in transaminases rapidly improved and returned to baseline. Conclusion: Our experience suggests the possibility of a toxic reaction to polyethylene glycol in a small number of patients being treated with pegylated interferon, resulting in an acute hepatitic response which resolved when therapy was stopped or switched to non-pegylated interferon. Correspondence to: Peter R Mills, Gastroenterology Unit, Gartnavel General Hospital, Glasgow G12 0YN, UK, E-mail: [email protected]