In a US Cohort the Large Majority of Individuals with Acute Hepatitis C Experience Spontaneous or Therapy-induced Viral Clearance

Acute hepatitis C virus (aHCV) infection progresses to chronicity in up to 80% of cases. Recent reports from Europe indicate that early treatment of aHCV produces sustained virologic response (SVR) rates as high as 98%.

However, the outcome of aHCV in the US, where response rates to antiviral therapy for chronic HCV are consistently lower than those observed in Europe, is not well characterized. In this study, researchers describe the outcomes of 12 cases of aHCV at their institution.

Records of patients diagnosed with aHCV from 2000-03 were reviewed. aHCV was diagnosed on the following grounds: ALT > 10xULN, HCV RNA detectable, and documented anti-HCV seroconversion.

Results

Of the 12 patients with aHCV, 10 (83%) experienced spontaneous or treatment-induced sustained virologic clearance and 2 remain viremic (one treated - responder-relapser, one untreated - contraindicated).

Those patients who spontaneously cleared virus did so at a median of 64 days and all cleared HCV RNA by 96 days.

Five patients were treated with IFN-alfa 2b (PEG-Intron) + ribavirin (RBV) and 3 were treated with peginterferon-alfa 2a (Pegasys) or 2b (PEG-IFN) +/- RBV for a mean of 30.7 (+/- 12) weeks.

Antiviral therapy was initiated at a median of 21 days following onset of symptoms. Those patients who spontaneously cleared HCV did so at a median of 64.5 days.

SVR was observed in 7 of 8 (88%) treated patients. One patient (pt 9), on hemodialysis, was treated initially with 12 weeks of IFN 3MU tiw and relapsed, then experienced SVR after 24 weeks of PEG-IFN.

Conclusions

The authors conclude, “Our experience with treated and untreated aHCV is comparable to that observed in Europe. Symptomatic patients with jaundice appear to be more capable of spontaneous clearance.”

“Treated patients had an excellent response to therapy. Overall, the great majority experienced either spontaneous or treatment-induced clearance.”

“Given the findings of this and other series, trials of immediate versus delayed treatment of aHCV are warranted. In view of these positive outcomes, increased vigilance for the diagnosis of acute HCV is essential.”

05/19/04

Reference
A Ross and R T Chung. Natural History of Acute Hepatitis C in a U.S. Cohort. Abstract 2021 (poster).   Digestive Disease Week. May 15-20, 2004. New Orleans, LA.