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Background: There is currently no accepted treatment of chronic hepatitis E virus (HEV) infection. Objective: To report 2 patients in whom ribavirin therapy seemed to alter the natural history of chronic HEV infection. Design: Case reports. Setting: Hepatology unit of a tertiary care center in France. Patients: A kidney and pancreas transplant recipient and a patient with idiopathic [CD4.sup.+] T lymphocytopenia, both with biopsy-proven chronic HEV infection. Intervention: Patients received oral ribavirin, 12 mg/kg of body weight daily for 12 weeks. Measurements: Liver function tests, detection of HEV RNA (viremia and stool shedding) by reverse transcriptase polymerase chain reaction, and anti-HEV IgM and IgG antibodies. Results: Both patients had normalized liver function test results after 2 weeks of treatment and cleared HEV after 4 weeks of treatment. Hepatitis E virus RNA remained undetectable in the serum and stools throughout follow-up (3 months and 2 months for the first and second patient, respectively). Side effects were considered mild. Limitation: Given the relatively short follow-up, the achievement of HEV eradication could not be claimed. Conclusion: Ribavirin is a potentially effective treatment of HEV infection and should be evaluated in patients with chronic HEV infection. Primary Funding Source: None.

Background: The effect of regression of cirrhosis in chronic hepatitis C is unknown. Objective: To evaluate the relation between regression of cirrhosis and clinical outcome in patients with chronic hepatitis C after antiviral therapy. Design: A cohort of patients with cirrhosis treated between 1988 and 2001. Setting: Hepatology unit of a tertiary care center in France. Patients: 96 patients with chronic hepatitis C and biopsy-proven cirrhosis (METAVlR score F4) who were treated with an interferon-based regimen and had at least 1 posttreatrnent liver biopsy. Patients were followed until November 2006. Measurements: Occurrence of a combined end point of liver-related events (ascites, hepatic encephalopathy, variceal bleeding, spontaneous bacterial peritonitis, hepatocellular carcinoma, or liver transplantation) and death in patients with regression of cirrhosis (defined as a decrease from 4 to [less than or equal to] 2 METAVIR units on post-therapy liver biopsy). Results: The median follow-up was 118 months (interquartile range, 86 to 138 months). Eighteen patients had regression of cirrhosis. The incidence of the combined end point per 100 patient-years was 0 in patients with regression of cirrhosis and 4 in patients without regression of cirrhosis (P = 0.002, log-rank test). The transplantation-free survival rate at 10 years was 100% in patients with regression of cirrhosis and 74.2% in patients without regression of cirrhosis (P = 0.025). Limitations: Selection of patients was retrospective; selection and survival biases may have influenced the estimates of the overall rate of regression of cirrhosis. The low number of patients who experienced regression of cirrhosis precludes analysis of factors that could predict regression of cirrhosis. Conclusion: Regression of cirrhosis occurs after antiviral therapy in some patients with chronic hepatitis C. Regression is associated with decreased disease-related morbidity and improved survival.