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  • Review Article
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Treatment of acute HCV infection

Nature Reviews Gastroenterology & Hepatology volume 8, pages 265–274 (2011)Cite this article

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Abstract

In developed nations, the majority of new HCV infections are acquired by injection drug users. Acute HCV infection is generally asymptomatic and is followed by spontaneous viral clearance in approximately 25% of individuals. However, given the asymptomatic nature of infection and difficulties in identifying and following those at risk of acquiring infection, our knowledge of treatment for acute HCV infection has been hampered. Much of what is known about the timing, optimal regimen and duration of therapy comes from small, prospective, observational studies and randomized, controlled trials in selected populations. Furthermore, data on the treatment of acute HCV infection among injection drug users and patients co-infected with HCV and HIV are limited. Genetic testing for variations in IL28B may provide an additional diagnostic tool for the optimal management and treatment of acute HCV infection. This Review highlights current knowledge of the epidemiology, diagnosis, natural history and treatment of acute HCV infection, including proposed recommendations for the assessment and treatment of this infection.

Key Points

  • Injection drug use remains the major mode of acquisition of HCV infection in the developed world; however, a rise in sexual transmission of HCV infection in HIV-positive populations has been observed

  • Spontaneous HCV clearance occurs in ∼25% of individuals and is associated with host (sex, initial immune response, IL28B genotype, other genetic factors) and viral (viral quasispecies and HCV genotype) factors

  • Decisions about when to initiate treatment for acute HCV infection should be carefully considered in the context of the estimated date of infection, HCV RNA testing and IL28B genotype

  • In patients who have acute HCV mono-infection, 24 weeks of PEG-IFN treatment is recommended

  • In patients who have acute HCV and HIV co-infection, PEG-IFN and ribavirin treatment with response-guided duration of therapy (based on rapid virological response) is recommended, but further data are needed

  • Among injection drug users who have acute HCV infection, each decision to treat must be made on a case-by-case basis and injection drug use should not be a contraindication to therapy

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  1. Viral Hepatitis Clinical Research Program, National Center in HIV Epidemiology and Clinical Research, University of New South Wales, Ground Floor, CFI Building, Corner Boundary and West Streets, Darlinghurst, NSW 2010, Sydney, Australia

    Jason Grebely, Gail V. Matthews & Gregory J. Dore

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J. Grebely is on the Speakers Bureau and has received grant/research support from Merck. G. V. Matthews is a Consultant, is on the Speakers Bureau and has received grant/research support from Merck and Roche. She is also on the Speakers Bureau for Bristol-Myers Squibb and has received grant/research support from Gilead. G. J. Dore is a Consultant, is on the Speakers Bureau and has received grant/research support from Merck and Roche. He is also a Consultant for Abbott and Tibotec.

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Grebely, J., Matthews, G. & Dore, G. Treatment of acute HCV infection. Nat Rev Gastroenterol Hepatol 8, 265–274 (2011). https://doi.org/10.1038/nrgastro.2011.32

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