By Liz Highleyman

The incidence of acute hepatitis C virus (HCV) infection has fallen in recent years, mainly due to effective blood screening and increased education about the risk of needle sharing. However, new HCV infection is still common among certain populations such as injection drug users. S.M. Kamal of Ain Shams Faculty of Medicine in Cairo, Egypt, presented a systematic review of acute hepatitis C in the May 2008 issue of the American Journal of Gastroenterology.

Some people with acute hepatitis C -- referring to the first 6 months after infection -- experience symptoms such as fatigue, loss of appetite, and abdominal pain. However, because these non-specific symptoms are associated with a variety of illnesses, and because more than half of newly infected individuals experience no symptoms, acute hepatitis C is seldom diagnosed during the acute stage.

Kamal and colleagues surveyed the medical literature looking for predictors of spontaneous clearance and treatment outcomes during the acute stage of HCV, in order to identify factors that might assist in treatment decision-making. They conducted a search of the MEDLINE database using the keywords "acute hepatitis C" with a variety of additional keywords focused on epidemiology, natural history and outcome, diagnosis, mode of transmission, and treatment.

The studies revealed no reliable predictors of spontaneous resolution of HCV infection. Some clinicians prefer to treat acute HCV to prevent the development of chronic hepatitis. Several clinical trials have shown that interferon-based therapy during the acute phase produces high sustained virological response (SVR) rates ranging from 75% to 100%.

However, decisions about whether to treat remain difficult due to the side effects and cost of therapy and the fact that a significant proportion of infected individuals -- estimated at around 25% -- would clear the virus anyway without treatment.

"Although there is a prevailing consensus that intervention during the acute phase is associated with improved viral eradication, relevant clinical questions have remained unanswered by clinical trials," Kamal wrote. "Optimization of therapy for acute hepatitis C infection and identification of predictors of SVR represent a real challenge."

"With more than 170 million chronic hepatitis C patients worldwide and an increase in the related morbidity and mortality projected for the next decade," he continued, "an improvement in our ability to diagnose and treat patients with acute hepatitis C would have a significant impact on the prevalence of chronic hepatitis and its associated complications particularly in countries with a high endemic background of the infection."

6/17/08

Reference
S Kamal. Acute hepatitis C: a systematic review. American Journal of Gastroenterology 103(5): 1283-1297. May 2008.