A short course of pegylated interferon‐α in acute HCV hepatitis

Abstract

Acute hepatitis C virus (HCV) infection evolves to chronicity in 50-84% cases. Treatment with interferon-alpha (IFN-alpha) was repeatedly found to provide sustained cure rates higher than that in chronic HCV infection, but the optimal treatment strategy has not yet been defined. In a multicentre open-label study, we investigated the therapeutic performance of a short course of pegylated (peg) IFN-alpha in patients with acute HCV hepatitis. Peg IFN-alpha2b, 1.0-1.5 micro g/kg weekly, was administered for 12 weeks. Forty-six patients were enrolled; 26 of them were intravenous drug users. Eleven patients had jaundice. Treatment was started within 1-90 days from the peak alanine aminotransferase. Treatment was well tolerated with a single dropout (2%). Thirty-three of 46 patients (72%) had a sustained virological response (SVR) after a 6 months post-treatment follow-up, 8 (17%) relapsed after treatment and 4 were nonresponders (9%). A lower peak viraemia, receiving at least 1.2 micro g/kg of peg IFN-alpha, and a negative HCV-RNA at week 4 and week 12 were predictors of SVR. Thus, in patients with early (week 4) viral response, a short course of peg IFN-alpha at a weekly dose >1.2 micro g/kg, may be a valuable option for the treatment of acute HCV hepatitis.

Acute hepatitis C in Spain: a retrospective study of 131 cases

“…RNA-HCV undetectable at week 4 in our series was related to a cure rate of 98%; in these patients treatment with PEG-IFN is unnecessary (35). In contrast, only 69% of patients with detectable HCV-RNA at week 4 were cured.…”

“…Thus, jaundice was related to SVC, a finding similar to other series. Several studies suggest that symptomatic and jaundiced patients have a higher rate of SVC and SVR (8,9,18,23,25,(34)(35)(36)(37), possibly associated with a better response of the immune system (29,36).…”

Therapeutic approach to acute hepatitis C

“…Nevertheless, to date, the ideal treatment regimen to be adopted in clinical practice has not been established [4,6,8,9,14,18,19,24]. Comparing results from different clinical trials is difficult for the following reasons: acute hepatitis C is frequently asymptomatic; different criteria are used in case definition; samples of patients are small and heterogeneous; there are no control groups; different types and doses of interferon (IFN) are used; there are different end points, and follow-up time varies enormously.…”

“…This viral clearance can occur, in rare situations (in 10-50% of cases), up to 24 weeks after symptom onset [8,9,[12][13][14][15]17,18,21]. Various authors suggest that the treatment be initiated, at most, 12 to 16 weeks after symptom onset, avoiding unnecessary exposure to IFN in patients who can clear HCV spontaneously [4,10,12,18,33].…”

“…In view of the impossibility of immunoprevention [5] -either through vaccines or the use of post-exposure immunoglobulin -and the risk of chronicity in individuals exposed to the disease, which is estimated to be between 50% and 85% [2,4,[6][7][8][9]33], the definition of strategies aimed at early detection and treatment of infected individuals, preferably during the acute phase of the infection [2,4], has been widely discussed in recent years.…”