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