What are the treatment options for acute hepatitis C (hep C) infection?

Updated: Oct 07, 2019
  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: BS Anand, MD  more...
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Answer

Acute hepatitis C virus (HCV) infection is defined as presenting within 6 months of the exposure. During this time, there is a 15% to 50% chance of spontaneous resolution of infection. [1, 16, 34, 35] Monitoring for spontaneous clearance for a minimum of 6 months before initiating treatment is recommended. In the past, interferon (IFN)-based treatment was used with high cure rates of acute infection. However, IFN-sparing regimens are safer and are currently recommended for the treatment of acute HCV infection. [34]

When the decision is made to initiate treatment after 6 months, the same regimens that are recommended for chronic HCV infection are recommended for acute infection. [34]

The following recommendations are based on HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C, guidelines from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Disease Society of America (ISDA). [9]

Medical management and monitoring of acute HCV infection

Recommendations [9]

  • Regularly monitor with laboratory studies in the setting of acute HCV infection. In addition, monitor HCV RNA (eg, every 4-8 weeks) for 6 to 12 months to determine spontaneous clearance versus persistence of HCV infection.
  • Counsel patients with acute HCV infection to avoid hepatotoxic insults, including hepatotoxic drugs (eg, acetaminophen) and alcohol consumption, and to reduce the risk of HCV transmission to others.
  • Refer to an addiction medicine specialist for patients with acute HCV infection related to substance use.
  • If a decision to delay initiation of treatment is acceptable to the clinician and patient, monitor for spontaneous clearance for at least 6 months. If, after 6 months, a decision is made to initiate therapy, treat as previously discussed under the section  Treatment-Naïve Patients with Chronic Hepatitis C Infection
  • If a decision to initiate treatment is made during the acute infection period, before starting therapy, monitor HCV RNA levels for at least 12-16 weeks for possible spontaneous clearance.
  • The same treatment regimens recommended for chronic HCV infection are recommended for acute HCV infection.

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