Acute Hepatitis C: To Treat or Not to Treat?

Should acute infection with hepatitis C virus (HCV) be treated? If yes, what is the recommended treatment? -- Percy Kepfer, MD Fort Pierce, Fla

Once acute HCV infection has been diagnosed, monitor the patient. In those who spontaneously clear an acute infection, clearance usually occurs within 3 months of the known onset of hepatitis. If HCV viremia has not cleared by 3 months, it is highly likely that the infection will become chronic.

Although no randomized controlled trials have addressed this question, I recommend a 3- to 6-month course of peginterferon-based therapy (with or without ribavirin) in those patients who have failed to clear acute infection. Success rates in this setting (ie, rates of sustained viral clearance) approach 90%. The importance of early treatment is clear: these success rates vastly eclipse those seen in patients with chronic infection.

-- Raymond T. Chung, MD Associate Professor of Medicine Harvard Medical School Director of Hepatology Medical Director, Liver Transplant Program Massachusetts General Hospital Boston