Acute hepatitis C
This section gives information on the natural history of acute hepatitis, guidance on post-exposure prophylaxis, and recommendations on the timing, choice and duration of treatment for acute hepatitis C.
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Natural history
The incidence of acute hepatitis C is unknown but can be estimated from the prevalence of chronic hepatitis C (CHC).63 Acute hepatitis C infection is usually asymptomatic. 64 The full clinical spectrum of acute hepatitis C symptoms can occur but is rare (<15% patients).65 The mortality of acute hepatitis C is very low (0.1% or less) and chronic infection is the most common outcome.63, 65, 66 3
Laboratory diagnosis should start with testing for anti-HCV but in early cases HCV RNA may be the only marker of infection (see HCV Diagnostic testing).67 2+
Spontaneous recovery occurs in 30-50% of patients with symptomatic infection, usually within three months of diagnosis. This is most common in females with an icteric illness.63, 64, 68, 69 3
Patients with acute hepatitis C virus infection require clinical and laboratory monitoring (looking for spontaneous viral clearance) for the initial three months following diagnosis as they will often have a self limiting illness.
Post-exposure prophylaxis
No trials were identified that show whether or not immunoglobulin, IFN based therapies or antiviral agents are effective at preventing transmission when given immediately post-exposure. Two reviews which considered older studies of immunoglobulin did not establish efficacy and concluded that immunoglobulin and IFN based therapies are not recommended after HCV exposure.26, 70 4
Treatment of patients with acute hepatits C
Timing of treatment
Most patients who spontaneously clear hepatitis C do so within 12 weeks of diagnosis.63, 69 There are no data to suggest that delaying treatment from three to six months post-diagnosis compromises treatment response, whilst allowing for spontaneous clearance to occur.43 Delaying treatment to one year post-acquisition compromises a sustained viral response.43 3 1++
Treatment should start between three and six months after diagnosis of acute hepatitis C, if the infection has not resolved spontaneously.
Choice and duration of treatment
Two systematic reviews examined the effectiveness of non-pegylated IFN for the treatment of patients with acute hepatitis C.71, 72 In one study participants in the treatment groups had higher sustained viral response rates (62%) than those in untreated groups (12%).71 A Cochrane review demonstrated that increasing the dose of non-pegylated IFN during the induction phase of treatment was associated with higher sustained viral response.72 There are no data on the influence of genotype on response to treatment for acute hepatitis C infection. 1+
No randomised controlled trials (RCTs) of pegylated IFN versus conventional IFN for patients with acute hepatitis C were identified. A case series treated 16 patients, who had not seroconverted by three months, with pegylated IFN alone for 24 weeks, and reported a sustained viral response of 94%.63 3
Patients with acute HCV infection should be treated with IFN therapy if the infection does not resolve spontaneously.
Patients can be treated with either pegylated IFN or non-pegylated IFN.
Patients with acute HCV infection should be treated with IFN therapy for 24 weeks irrespective of genotype.
