be taken into account to assess the efficacy of the treatment. Even if both CAH and LC are diseases with homogeneous diffusion of the liver damage, it may happen that the damage might be not uniformously distributed into the hepatic pa- renchyma. Based on this observation, different authors sup- port the idea that by liver biopsy the diagnosis of LC might be underestimated in about 50% of the patients (4). Some data indicate that the diagnoses of LC from two consecutive specimens, obtained one after the other during a short period of time, diverted in about 50% of the cases (4). The results presented in Table 1 differ from those of Regev et al. (5), recently published at the American Association for the Study of Liver Diseases meeting. In this paper the authors describe, for grading and staging, respectively, 24.2% and 33.1% of discordances between the two biopsies made in the two lobes via laparoscopy. They concluded that the diag- nosis of LC was underestimated in 14.5% of the cases. The difference with our results might be explained by the char- acteristics of the populations considered in the two studies. In our cohort we excluded patients with LC, but they were included in the study of the French group. Results presented in this letter support the hypothesis that the histological examination of a unique liver specimen may be considered a reliable and reproducible marker either of the inflammatory activity or of the fibrosis of the entire liver. This seems to be valid at least in the case of patients affected with noncirrhotic chronic liver disease. Marcello Persico, M.D. Bruno Palmentieri, M.D. Raffaela Vecchione, M.D. Roberto Torella Ilario de Sio, M.D. Department of Internal Medicine Hepatology and Gastroenterology Second University of Naples Pathology Unit Federico II University Naples, Italy REFERENCES 1. Papini E, Pacella CM, Rossi Z, et al. A randomized trial of ultrasound guided anterior subcostal liver biopsy versus the conventional Mengini technique. J Hepatol 1991;13:291–7. 2. Schalm S. The diagnosis of cirrhosis: Clinical relevance and methodology. J Hepatol 1997;27:1118 –9. 3. Abdi W, Millian JC, Mezey E. Sampling variability on percu- taneous liver biopsy. Arch Intern Med 1979;139:667–9. 4. Pagliaro L, Rinaldi F, Craxi A, et al. Percutaneous blind biopsy versus laparoscopy with guided biopsy in diagnosis of cirrhosis. A prospective, randomized trial. Dig Dis Sci 1983;28:39 – 43. 5. Regev A, Berho M, Jeffers LJ, et al. Sampling error associated with a needle liver biopsy in patients with chronic hepatitis C virus infection. Hepatology 1999;30(suppl):438. Reprint requests and correspondence: Marcello Persico, M.D., Via T. Tasso 169, 80127 Napoli, Italy. Received Aug. 16, 2001; accepted Aug. 22, 2001. Three Times Weekly Versus Daily Dose -Interferon Treatment in Patients With Acute Hepatitis C TO THE EDITOR: It has been reported that more than 80% of patients with acute hepatitis C develop chronic hepatitis (1). To avoid the progression toward chronic hepatitis, many controlled and uncontrolled studies of interferon therapy in patients with acute hepatitis C have been performed (2, 3). It has emerged that a short course of low-dose interferon treatment is significantly more effective than no treatment in obtaining both aminotransferase normalization and HCV RNA clearance (1). However, the better dosage and the optimal duration of -interferon treatment remain unde- fined. In patients with chronic hepatitis C, Nakamura et al. (4) reported that daily dosing was superior to three times weekly dosing, and Vogel et al. (5), using 10 MU of -in- terferon daily for 4 – 6 wk, reported a primary response (HCV RNA negativization and aminotranferase normaliza- tion) in 90% of patients with acute hepatitis C. From these data we designed a randomized trial aimed at comparing the efficacy of the most common protocol used in the treatment of patients with acute hepatitis C (-interferon, 3 MU three times/wk for 12 wk) to that of a daily dose protocol (- interferon, 3 MU/day for 36 days). Fourteen patients (10 male, mean age = 32.4 yr [range = 21–38]) were enrolled in this study. The diagnosis of acute hepatitis C was based on documented seroconversion to anti-HCV and symptom- atic acute liver hepatitis. None of these patients was coin- fected with HIV or hepatitis B virus. Eight patients were assigned to receive -interferon (3 MU three times/wk) and six to the daily dose protocol. At baseline all patients were HCV RNA positive and had aminotranferases over two times the normal values. As risk factors, 10 patients had a histories of i.v. drug use, whereas in four cases no evident risk factor could be identified. The viral titer was measured at baseline by the Amplicor HCV Monitor test (version 2, Roche Diagnostics, Basel, Switzerland), whereas HCV RNA was monitored during and after treatment with qual- itative polymerase chain reaction (Amplicor, Roche Diag- nostics). At baseline, no significant differences in terms of Table 1. Comparison of Histological Scores Between the Left and Right Liver Lobes Right Lobe Left Lobe p Total score 8.13  4.56 8.06  4.56 0.95 Grading 6.03  3.25 6  3.22 0.97 Grading A 1.88  1.1 1.81  1.09 0.79 Grading B 0.66  1.18 0.63  1.18 0.92 Grading C 1.66  0.97 1.72  1.02 0.81 Grading D 1.78  0.91 1.78  0.91 1 Staging 2.16  1.65 2.13  1.66 0.94 492 Letters to the Editor AJG – Vol. 97, No. 2, 2002