Spontaneous viral clearance in patients with acute hepatitis C can be predicted by repeated measurements of serum viral load

Abstract

Early interferon (IFN) therapy prevents viral persistence in acute hepatitis C, but in view of the resulting costs and morbidity patients who really need therapy have to be identified. Twelve consecutive patients with acute hepatitis C (9 women, 3 men, mean age: 39.5 ؎ 18.8 y, genotype 1: 7, genotype 3a: 3, 2 could not be genotyped) were studied. The sources of infection were medical procedures in 6, sexual transmission in 3, and intravenous drug abuse in 3 patients. N atural history of acute hepatitis C virus (HCV) infection is variable. Progression to chronic hepatitis occurs in 50% to 84% of cases. [1][2][3][4][5][6][7][8][9] This variation can be partly explained by the mode of transmission of HCV, viral factors, and by the ability of the host to mount a strong T-cell response to eliminate the virus. Acute HCV infection generally has a mild course, most cases are asymptomatic, and fulminant hepatic failure is very rare. 10,11 The long-term sequelae of chronic hepatitis are the subject of ongoing discussions. Carefully conducted epidemiologic studies in well-documented cases of acute hepatitis C indicate that disease follows a very mild course and that occurrence of cirrhosis within the first 25 years after infection is rare. 2,3,7 Treatment of chronic hepatitis C, especially in patients infected with genotype 1 or 4, is still unsatisfactory. Despite improvements in response rates, current combination therapy with pegylated interferon (IFN) alfa-2a or -2b and ribavirin for chronic hepatitis C infection yields response rates from 54% to 56%. 12,13 Prevention of chronicity by early antiviral treatment thus may be important. Because of the infrequent nature of acute hepatitis C the impact of early antiviral therapy has not been well studied and is conflicting. 14 Only in 2 of 6 controlled trials using 3 MU IFN-2b 3 times a week for 6 to 24 weeks 15 eradication of HCV RNA was assessed. In general, transition to chronicity was not different from untreated controls. Only one study using 10 MU of IFN-2b until normalization of transaminase levels reported an 82% sustained virologic response. 16 A recent study 17 using 5 MU IFN alfa-2b for 6 months showed a 98% HCV eradication in Abbreviations: HCV, hepatitis C virus; IFN, interferon; ALT, alanine transaminase. From the

Outcomes and Treatment of Acute Hepatitis C Virus Infection in a United States Population

“…Untreated, acute HCV infection progresses to chronic infection in 50-80% of patients (3)(4)(5) while the remainder appear to be able to clear the virus on their own. Several studies have suggested that female sex, symptomatic disease and high peak bilirubin levels are the strongest predictors of spontaneous viral clearance (6).…”

Bi-allelic presence of the interleukin-10 receptor 1 G330R allele is associated with cirrhosis in chronic HCV-1 infection

“…Chronic hepatitis develops in 33-84% of patients with acute hepatitis C. [1][2][3][4] Once, chronicity has established, about one-third of patients develop liver cirrhosis within 15-25 years 5,6 with an annual risk of hepatocellular carcinoma in 1-4% in cirrhotic livers. [7][8][9] Several factors such as alcohol abuse, coinfection with HBV or HIV, gender or age at infection determine the highly variable course of liver disease in hepatitis C virus (HCV) infection.…”

Acute hepatitis C: In search of the optimal approach to cure

“…Although serial assessment of IgM anti-HCV titres may help, 10 this test is not readily available, and only evaluation of the viral kinetics in the first weeks after presentation is really predictive of spontaneous clearance. 11 Since 2001, when a cohort study by Jaeckel et al 12 demonstrated that 6 months of treatment with standard IFN alfa 2b at doses comparable to those used for chronic hepatitis was enough to eradicate HCV infection in 98% of patients with acute hepatitis C, the issue of optimal treatment of AVH due to HCV has been a matter of hot debate. Albeit a fair number of studies (reviewed by metaanalysis in 13 ) show a net benefit of IFN therapy over no treatment in terms of duration of viraemia, rate of chronicity, and duration of biochemical alterations, there is still no consensus on whom to treat and the timing of treatment.…”