Enhancing the detection and management of acute hepatitis C virus infection

• PWID represent one of the groups at highest risk of transmitting and acquiring HCV.
• Recent increases in HCV incidence in young adults using prescription opioids are noted.
• HIV-positive MSM represent another high-risk group for acute HCV infection.
• Intervention in acute infection may have individual and population level benefits.
• The role of new therapeutic agents in the treatment of acute HCV is under evaluation.

Acute HCV infection refers to the 6-month period following infection acquisition, although this definition is somewhat arbitrary. While spontaneous clearance occurs in approximately 25%, the majority will develop chronic HCV infection with the potential for development of cirrhosis, end stage liver disease and hepatocellular carcinoma.Detection of acute HCV infection has been hampered by its asymptomatic or non-specific presentation, lack of specific diagnostic tests and the inherent difficulties in identifying and following individuals at highest risk of transmitting and acquiring HCV infection, such as people who inject drugs (PWID). However, recognition of those with acute infection may have individual and population level benefits and could represent an ideal opportunity for intervention. Despite demonstration that HCV treatment is feasible and successful in PWID, treatment uptake remains low with multiple barriers to care at an individual and systems level. Given the burden of HCV-related disease among PWID, strategies to enhance HCV assessment, treatment and prevention in this group are urgently needed. As the therapeutic landscape of chronic HCV management is revolutionised by the advent of simple, highly effective directly-acting antiviral (DAA) therapy, similar opportunities may exist in acute infection.This review will discuss issues surrounding improving the detection and management of acute HCV infection, particularly in PWID.