Elsevier

Clinics in Liver Disease

Volume 14, Issue 1, February 2010, Pages 169-176
Clinics in Liver Disease

Management of Acute Hepatitis C

https://doi.org/10.1016/j.cld.2009.11.007Get rights and content

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Diagnosis of acute HCV infection

An accurate diagnosis of acute HCV infection can often be elusive. The most accepted method of diagnosis is the documentation of recent (ie, in the previous 6 months) seroconversion of HCV antibody associated with detectable HCV RNA and elevated liver enzymes. These stringent diagnostic criteria can only be fulfilled during the follow-up of a documented needle-stick exposure or by prospective surveillance of high-risk groups, such as injection drug users. When these criteria are not met,

Treatment of acute HCV infection

Unlike the treatment of chronic HCV infection, the published studies show considerable heterogeneity with regard to trial design (randomized vs nonrandomized), inclusion criteria (type of exposure and methods of diagnosis), patient characteristics, treatment introduction relative to exposure date or onset of symptoms, and treatment modality (varying schedules of interferon [IFN] and ribavirin doses and durations). This makes it harder to make firm recommendations or provide a specific algorithm

Optimal timing of treatment

Although treatment of acute HCV infection is highly effective, the immediate introduction of treatment is not recommended for all patients, especially those with symptomatic infection, because many of them may undergo spontaneous viral clearance. The goal of therapy is to avoid treatment in those patients who are more likely to undergo spontaneous viral clearance and treat others when treatment is likely to be most effective.

The incidence of spontaneous clearance of HCV infection is highest

Duration of treatment

The benchmark study using conventional IFN therapy demonstrated an SVR rate of 98% with 24 weeks of therapy.11 Japanese investigators suggested that a shorter course of daily IFN for 4 weeks was also highly efficacious. They demonstrated viral clearance in 87% with 4 weeks of daily IFN therapy, and reserved 24-week treatment only for the relapsing group, achieving SVR rates of 100%.14 However, the treatment regimens used in these studies have not been duplicated and with the advent of PEG-IFN,

Optimal treatment regimen

There is no consensus on a standardized treatment regimen, mainly because the studies published to date have included heterogeneous patient populations without any direct comparisons between various treatment modalities. Early Japanese studies used IFN-β, whereas the European and American studies have used IFN-α. The dose of conventional IFN used in various studies has also been variable. With the approval of the PEG-IFNs and evidence of improved efficacy in patients with chronic hepatitis C,

Treatment of HIV–co-infected or hemodialysis patients

Recent outbreaks of acute HCV infections related to sexual exposure among the MSM (men who have sex with men) populations have been reported from HIV treatment centers in London and Paris. This has prompted a few small single-center trials for the treatment of acute HCV infection among patients with prior HIV infection. Data from these trials suggest that the rate of viral clearance among the HIV co-infected population is lower than that seen in the HCV mono-infected patients. Gilleece and

Summary

The identification of acute HCV infection represents a unique window of opportunity for achieving high rates of viral clearance. A waiting period for observation of 12 weeks is recommended for patients with symptomatic hepatitis to allow for spontaneous viral clearance that can occur at high rates in this subgroup. Asymptomatic patients may be treated immediately as they are less likely to undergo spontaneous clearance. Treatment durations could vary from 24 to 48 weeks, but recent data on 12

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