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Acute hepatitis C: To treat or not to treat?
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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