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Acute hepatitis C: To treat or not to treat?
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Hepatology
June 2002, Volume 35, Number 6
Background In people who are infected with the hepatitis C virus (HCV),
chronic infection often develops and is difficult to eradicate. We sought to
determine whether
treatment during the acute phase could prevent the development of chronic
infection.
Methods Between 1998 and 2001, we identified 44 patients throughout Germany
who had acute hepatitis C. Patients received 5 million U of interferon alfa-2b
subcutaneously daily for 4 weeks and then three times per week for another 20
weeks. Serum HCV RNA levels were measured before and during therapy and 24
weeks
after the end of therapy.
Results The mean age of the 44 patients was 36 years; 25 were women. Nine
became infected with HCV through intravenous drug use, 14 through a
needle-stick injury,
7 through medical procedures, and 10 through sexual contact; the mode of
infection could not be determined in 4. The average time from infection to the
first signs or
symptoms of hepatitis was 54 days, and the average time from infection until
the start of therapy was 89 days. At the end of both therapy and follow-up,
43 patients (98
percent) had undetectable levels of HCV RNA in serum and normal serum alanine
aminotransferase levels. Levels of HCV RNA became undetectable after an
average
of 3.2 weeks of treatment. Therapy was well tolerated in all but one patient,
who stopped therapy after 12 weeks because of side effects.
Conclusions Treatment of acute hepatitis C with interferon alfa-2b prevents
chronic infection.
This study by Jaeckel et al. is an important and timely one. It has shown
quite conclusively the excellent prognosis associated with IFN treatment in
acute hepatitis C.
Interferon's effectiveness in this setting may include its direct antiviral
activity in cells already infected, reduction of spread of HCV to uninfected
hepatocytes, and
augmentation of HCV-specific cellular immune responses.21-23 It also suggests
that 6 months of IFN monotherapy treatment may be sufficient even for
genotype 1
infections. With future studies the dosing regimen will be refined and new
therapeutics will likely emerge. Although the potential benefit of IFN
treatment in acute HCV
appears clear, there are many remaining challenges and questions. For
example, how can we identify patients with acute hepatitis C, including the
asymptomatic
patients? What are the relevant host and viral factors that contribute to the
outcome and IFN response in acute hepatitis C? The current study is clearly
an important
step in the direction of gaining a more complete understanding of the
host-virus interaction and the answers to the outstanding questions.
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