Therapy of acute hepatitis C

Abstract

Acute hepatitis C has a high propensity to become chronic, which provides the rationale for treating patients with acute disease attempting to prevent chronicity. Almost all published studies on therapy of acute hepatitis C have been small in size, uncontrolled, and highly heterogeneous as to patient features, dose and duration of treatment, follow-up evaluation, and criteria used to define efficacy and safety. The published studies on treatment of acute hepatitis C have used standard alfa or beta interferon monotherapy: none have evaluated combination therapy of interferon and ribavirin or peginterferon. Several meta-analyses of published studies have concluded that initiation of interferon monotherapy during the acute phase of hepatitis C virus (HCV) infection significantly reduces (by 30% to 40%) evolution to chronic hepatitis. The tolerability of interferon in acute hepatitis C has been excellent, even in symptomatic and icteric patients; the side effects and adverse events being similar in type and frequency to those seen when treating chronic cases. Thus, currently available data support treatment of patients with acute hepatitis C, but data are insufficient to draw firm conclusions about which patients to treat, when therapy should be started, or what regimen is optimal. Future studies of adequate size and design should focus on efficacy and tolerability of peginterferons and whether therapy should be started immediately after diagnosis or delayed for 2 to 4 months to avoid treatment of patients who spontaneously recover.(HEPATOLOGY 2002;36:S195-S200.) nfection with the hepatitis C virus (HCV) is the major cause of chronic liver disease, cirrhosis, and hepa-I tocellular carcinoma in many parts of the world.Acute HCV infection is typically mild and often asymptomatic, but has a high propensity to become chronic.The high chronicity rate of acute hepatitis C provides a strong rationale for antiviral therapy during the acute course of the illness, attempting to prevent chronic evolution. This approach has been supported by results of many studies of antiviral therapy in acute hepatitis C, but all have focused on monotherapy with either alfa or beta interferon. Furthermore, these studies have had several shortcomings: most were small in size and were highly heterogeneous as to the types of patients treated, regimen of therapy, and definitions of beneficial responses. There have been no recent studies using more rigorous regimens of therapy, such as combination therapy using interferon

Pegylated interferon alpha-2a and -2b in combination with ribavirin in the treatment of chronic hepatitis C: a systematic review and economic evaluation

“…Expected rates of spontaneous resolution of infection would be 30-50%. 123 Tolerability of IFN treatment in patients with acute infection was similar to that usually observed in chronic hepatitis C.…”

“…The current literature search strategies were not designed to uncover systematically all studies on this question, but a recent review by Alberti and colleagues 123 considered the studies published in this area. Unfortunately, there have been no published studies identified using PEG in patients with acute HCV.…”

“…123 Six of these were RCTs that included treated and untreated groups, and four were conducted in similar patient groups with post-transfusion hepatitis. In a meta-analysis of the four trials, IFN therapy was associated with a statistically significant 29% increase in the rate of SVR relative to no treatment.…”

Making the Best of a Bad Situation: Early Chronic Nosocomial HCV infection

“…Conversely, too lengthy a delay in therapy adversely affects treatment response. The optimal time of initiation of treatment remains a topic of debate, but most studies recommend waiting no longer than 8-16 weeks from transmission [14,15].…”

“…Pharmacologic therapy for acute HCV infection has not been standardized regarding medication or duration, but has been demonstrated to be cost-effective in two metaanalyses [14,16]. Interferon monotherapy, both unmodified and PEGylated, has been the mainstay of clinical trials and has been rewarded with very high rates of sustained virologic response (SVR).…”