Clinical epidemiology of acute hepatitis C in South America

Abstract

There is scarce data pertaining to acute hepatitis C (aHC) infection in South America. We aimed to describe clinical characteristics and evolution of aHC in a South American cohort. A retrospective survey was conducted at 13 hepatology units. All patients ≥16 years old with aHC diagnosis were included. Demographic, clinical and outcome information were registered in a standardized ad hoc questionnaire. Sixty-four patients were included. The majority were middle-aged (median age: 46 years) and female (65.6%); most of them were symptomatic at diagnosis (79.6%). HCV-1 was the most prevalent genotype (69.2%). Five patients had liver failure: three cases of severe acute hepatitis, one case of fulminant hepatitis and one case of acute-on-chronic liver failure. Nosocomial exposure was the most prevalent risk factor. Evolution was assessed in 46 patients. In the untreated cohort, spontaneous resolution occurred in 45.8% and was associated with higher values of AST/ALT and with the absence of intermittent HCV RNA viremia (P = 0.01, 0.05, and 0.01, respectively). In the treated cohort, sustained virological response was associated with nosocomial transmission and early treatment initiation (P = 0.04 each). The prevalence of nosocomial transmission in this South-American cohort of aHC stresses the importance of following universal precautions to prevent HCV infection. J. Med. Virol. 89:276-283, 2017. © 2016 Wiley Periodicals, Inc.

Acute hepatitis C from heterosexual transmission

“…The fact that hepatic cytolysis enzymes have decreased or tended to normalize, as occurred during the period of hospitalization of this patient, does not necessarily mean that the infection will resolve spontaneously. In fact, although some studies reveal spontaneous viral clearance around 50% [[9], [10], [11], [12], [13], [14]], and others reveal that symptomatic patients are more likely to spontaneous clearance [15,16], the truth is that acute phase provide an opportunity for early treatment of patients before they progress to chronicity.…”

Current Treatment Approach in Acute Hepatitis C Infection

“…It has been reported that factors influencing spontaneous clearance positively were being under 30 years of age, female gender, symptomatic infection, IL 28BCC genotype and HCV genotype 1, while independent predictive factors have been determined to be female gender, IL 28 B CC genotype and HCV genotype 1 (10,11,12). Spontaneous clearance was reported in 46-67% of symptomatic cases, while no spontaneous clearance observed in asymptomatic patients (13,14). The presence of jaundice may indicate a good immune response resulting in spontaneous clearance.…”

Chronic Hepatitis C: Acute Exacerbation and Alanine Aminotransferase Flare

“…In general, HCV-related ALF rarely occurs worldwide [ 18 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. However, the HCV cell-culture-grown virus JFH1 is derived from a Japanese fulminant hepatitis patient [ 46 , 47 ].…”

“…Theilmann et al also concluded that fulminant and subacute hepatic failure is induced by HCV only in few German patients with non-A, non-B hepatitis [ 27 ]. Thus, HCV-related ALF rarely occurs [ 18 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]; however, careful attention should be paid to some patients with severe presentation [ 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ].…”