Acute hepatitis C in Spain: a retrospective study of 131 cases

Abstract

Background and aims: the management of acute hepatitis C (AHC) is controversial. We have conducted a retrospective study to determine the epidemiological and biochemical aspects, the genotypes, the spontaneous clearance of HCV (SVC), and the treatment responses in patients with AHC.Methods: we have retrospectively collected data from 131 patients with AHC from 18 Spanish hospitals.Results: the mean age was 43 ± 16 years (17-83), 69% were symptomatic. The causes of infection were nosocomial in 40% and intravenous drug users in 20%. Eighty two percent had genotype 1. The delay from symptoms-onset to HCV-RNA confirmation was 50 ± 68 days (range, 11-350 days) and to treatment (in 59%) 14 ±1 3 weeks (range, 2-58 days). In the treated group, 80% achieved sustained virological response (SVR) versus 57% SVC in untreated patients (p = 0.004). Up to 96% of those treated within the first 12 weeks had SVR versus 86% of those treated later (p = 0.04). Patients with HCV-RNA(-) at week 4 resolved with or without treatment more frequently than those HCV-RNA(+) (98% versus 69%, p = 0.005). The treatment was not beneficial if HCV-RNA was undetectable at week 12. No differences in SVR were found in genotype 1 patients treated for 24 or 48 weeks. Patients with low baseline viral load achieved higher SVC and SVR. The SVC in patients with bilirubin > 5 mg/dL was 78 versus 40% in those with lower values (p = 0.004).Conclusions: the most common transmission route was nosocomial. SVR was higher in patients treated than SVC in non-treated. Early treatment (before week 12) achieved the highest response rate. SVC and SVR were more common in patients with a low baseline viral load. Undetectable HCV-RNA at week 4 was associated with high SVR and SVC rates. Jaundice was related with SVC.

Clinical epidemiology of acute hepatitis C in South America

“…Although the ages of our patients were similar to those reported in other aHC series [Kamal et al, ; Perez‐Alvarez et al, ; Bunchorntavakul et al, ], 44% of our patients (28 individuals) were 50 years or older at the time of infection. This rather high proportion of older patients may be related to the predominance of a nosocomial transmission source; it has been previously suggested that this risk factor prevails in older subjects (>50 years of age) [Perez‐Alvarez et al, ]; patients reporting sexual‐ or drug use‐related exposure were significantly younger. The small percentage of patients who declared drug use as a risk factor is concordant with previous reports; intravenous drug addiction related to HCV acquisition has been traditionally considered infrequent in South America [Findor et al, ].…”

“…Both in developed and developing countries, nosocomial transmission of aHC has been extensively reported, particularly since the incidence of HCV infection due to blood product transfusions and intravenous drug use has decreased [Maheshwari et al, ]. In a recent study conducted in Germany, medical procedures were the primary suspected source of infection [Gerlach et al, ]; similarly, in a Spanish retrospective analysis of 131 patients, 40% of patients reported a non‐transfusion related nosocomial source of infection [Perez‐Alvarez et al, ]. In a prior South American survey conducted in Brazil, the main risk factors for HCV transmission in aHC patients were related to hospital procedures or admission [Ferreira Ade et al, ].…”

A systematic review of Hepatitis C virus treatment uptake among people who inject drugs in the European Region

“…For 11 studies [20,22-25,27,28,30,33,36,37] included in the review, treatment uptake levels could be calculated specifically for current and former PWID (Table 5). (Other studies had study populations that included non-injecting drug users.)…”

Acute hepatitis C from heterosexual transmission

“…The fact that hepatic cytolysis enzymes have decreased or tended to normalize, as occurred during the period of hospitalization of this patient, does not necessarily mean that the infection will resolve spontaneously. In fact, although some studies reveal spontaneous viral clearance around 50% [[9], [10], [11], [12], [13], [14]], and others reveal that symptomatic patients are more likely to spontaneous clearance [15,16], the truth is that acute phase provide an opportunity for early treatment of patients before they progress to chronicity.…”