| Article ID | Journal | Published Year | Pages | File Type |
|---|---|---|---|---|
| 6106621 | Journal of Hepatology | 2012 | 7 Pages |
Background & AimsTiming of treatment initiation in acute hepatitis C (AHC) patients is unclear. Spontaneous viral clearance argues for a “watch-and-wait” strategy. However, early initiation of treatment could increase the sustained virological response (SVR) rate. We compared three different HCV treatment initiation strategies in patients with AHC according to presence of clinical symptoms and IL28B polymorphism: (1) within 2 months after transmission (immediate initiation), (2) at 3 months (early initiation), and (3) at 4/5 months (delayed initiation).MethodsWe calculated spontaneous HCV clearance probability based on the symptomatic (sAHC) and asymptomatic (aAHC) nature of disease and C/C or non-C/C genotype. We used different SVR probabilities according to delay between transmission and treatment. We estimated the probability of developing chronic hepatitis C (CHC).ResultsThe probability of developing CHC was lower for immediate treatment initiation (7.1% in C/C and 7.3% in non-C/C patients with sAHC; 6.6% in C/C and 7.1% in non-C/C patients with aAHC) than for delayed initiation (13.5% in C/C and 18.0% in non-C/C patients with sAHC; 14.6% in C/C and 18.5% in non-C/C patients with aAHC) regardless of the presence of symptoms or IL28B genotype.ConclusionsIn patients such as health care workers, in whom HCV is detected ⩽2 months following transmission, treatment should be immediately initiated regardless of clinical symptoms and IL28B polymorphism. In those in whom HCV is detected >2 months after transmission, treatment 4/5 months after may be preferable because of a higher rate of spontaneous HCV clearance after 2 months and a poor HCV treatment efficacy's differential between months 3 and 4/5.
