Treatment of acute hepatitis C virus infection

Chronic hepatitis C is the leading cause of liver-related morbidity and mortality in the Western world. Treatment response in the chronic phase of the disease is still unsatisfactory. Acute hepatitis C takes a chronic course in more than 50% of cases. Interferon therapy treatment in the acute presentation phase is, according to some studies, more efficient than in the chronic phase of disease. The aim of this study was to analyse the response to interferon in acute hepatitis C. This review is based on three published meta-analyses performed using the methods of DerSimonian and Laird. Outcome was assessed by normalisation of serum aminotransferases and clearance of HCV-RNA. Data were presented by calculating the risk difference, which estimated efficacy by calculating the proportion of patients in treatment groups who responded better (0 to 1.0) or worse (0 to −1.0) than untreated control groups. Three mega units of interferon-α2b (IFN) three times a week for 6–24 weeks produced a significant response as measured by long-term normalisation of aminotransferases and clearance of HCV-RNA. Overall rate differences were +0.31 (p<0.01; 95% confidence interval +0.19–0.43) and +0.33 (p<0.001; 95% confidence interval +0.08–0.58). Six MU of IFN three times a week for 16–24 weeks produced better results with a risk difference of +0.53 (95% confidence interval +0.17–0.89) for normalisation of aminotransferases and +0.44 (95% confidence interval +0.06–0.82) for clearance of HCV-RNA. In an uncontrolled trial, 10 MU IFN daily for 4–6 weeks produced clearance of HCV-RNA and normalisation of transaminases in 90% of patients. Twelve weeksʹ treatment of symptomatic acute hepatitis C with interferon produced a response similar to that of long-term treatment for chronic hepatitis C. More studies are needed to define the role of a higher dose and the start of treatment.