Therapy of acute hepatitis C

Alberti, Alfredo; Boccato, Silvia; Vario, Alessandro; Benvegnù, Luisa

doi:10.1053/jhep.2002.36808

Cited by 49 publications

(40 citation statements)

References 23 publications

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“…Whether this may be related to the timing of their diagnosis relative to their onset of infection is unclear. Patients within the incarcerated cohort presented later in the course of infection (median 5.0 months, IQR [2–7]) when compared to those with documented seroconversion, where the median estimated duration of infection was only 3.0 months, IQR [1–5] (Table 3). They also had a lower rate of symptomatic disease, which may have resulted from our systematic risk-based approach (43% vs. 86%, p<0.05).…”

Section: Resultsmentioning

confidence: 99%

“…The diagnosis of acute hepatitis C virus (HCV) infection is problematic because antibody testing does not differentiate between acute and chronic infection and seroconversion is often not documented [1, 2]. Physicians have traditionally made clinical judgments based on the presence of symptoms, viremia, abnormal aminotransferases, and a history of prior seronegativity [3].…”

Section: Introductionmentioning

confidence: 99%

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Improving the Diagnosis of Acute Hepatitis C Virus Infection with Expanded Viral Load Criteria

et al. 2009

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Background The diagnosis of acute hepatitis C virus (HCV) infection is imprecise because antibody testing does not differentiate between acute and chronic infection. While virologic features, such as viral load fluctuations and low levels of viremia, have been noted to be characteristic of acute HCV infection, these parameters have not been utilized for diagnosis. Methods We validated the use of these novel parameters (i.e., viral load fluctuations>1 log and HCV-RNA<100,000 IU/mL) in a cohort of acute HCV seroconverters. We then applied standard diagnostic criteria for acute HCV in a cohort of high-risk injection drug users entering prison with suspected acute HCV infection (n=37). We subsequently assessed whether these novel virologic parameters, measured serially over a 10-week period, could enhance the diagnosis of acute infection. Main results Low-level viremia and viral fluctuations were highly prevalent in our cohort of acute seroconverters (81 and 86 percent, respectively) while low-level viremia occurred in only 13% of control patients with chronic infection. Using standard criteria, 37 inmates were diagnosed with acute HCV infection. In the 35 patients with HCV-RNA at baseline, we found low-level viremia to be highly prevalent (n=27; 77%); in patients with a minimum of two HCV-RNA samples, we demonstrated viral fluctuations in more than one-third (n=9; 36%). Conclusions The diagnosis of acute infection in the HCV-seropositive patient is strengthened by the use of virologic parameters that are uncommon in chronic disease. Viral load fluctuations and low levels of HCV-RNA should be incorporated into standard diagnostic criteria.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improving the Diagnosis of Acute Hepatitis C Virus Infection with Expanded Viral Load Criteria

et al. 2009

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“…Of particular significance are several studies that demonstrate that acute HCV infection can be treated with virtually 100% success. (38–41). With respect to HIV, molecular tests have also been developed that accurately measure patients’ circulating viral burdens, and the past two decades have witnessed the development of highly active antiretroviral therapy that can, in many instances virtually suppress HIV replication.…”

Section: Discussionmentioning

confidence: 99%

Current Strategies for Managing Providers Infected with Bloodborne Pathogens

Turkel

Henderson

2011

Infect. Control Hosp. Epidemiol.

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Background In 1991 CDC issued guidelines to reduce risks for provider-to-patient transmission of bloodborne pathogens. These guidelines, unchanged since 1991, recommend management strategies for hepatitis B ‘e’ antigen-positive providers and for providers infected with human immunodeficiency virus (HIV); they do not address hepatitis-C-virus (HCV)-infected providers. Objective We summarize current state practices and surveyed state health departments to determine: 1) if state policies have been modified since 1991; 2), if state laws require prospective notification of patients and/or expert review panels to manage infected providers; 3) the frequency with which infected-providers issues come to the attention of state health departments; and 4) how state health departments intervene. Methods We reviewed all 50 states’ laws and guidelines to determine current practices and conducted a structured telephone survey of all state health departments. Results Whereas only 19 states require infected providers to notify patients of the providers’ bloodborne pathogen infection, these 19 states require notification under highly varied circumstances. Only ten of 50 state health department officials identified these issues as requiring significant departmental effort. No state law or guideline incorporates information about providers’ viral burdens as part of the risk assessment. Only 3/50 States have modified policies or laws since initial passage; and only 1/50 discusses the management of HCV-infected providers.. Conclusions These results identify a need for incorporating contemporary scientific information into guidelines and also suggest that infected-provider issues are not occurring commonly, are not being detected, or that they are being managed at levels below the state health department.

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“…If we had adopted the approach proposed by Garcia et al [1], obtaining an early diagnosis for the 6 subjects with seroconversion who did not develop symptoms-if of any advantage in treating them-would have required у3724 HCV RNA tests, assuming that a single test was sufficient to detect (or rule out) infection. Because there is no data indicating that early treatment of acute HCV infection is more effective than early treatment of chronic HCV infection [5] and because, in many cases, infection may resolve without therapy [6], the advantage of an early diagnosis though HCV RNA testing is debatable.…”

Section: Infection With Hepatitis C Virus Transmitted By Accidental Nmentioning

confidence: 99%

“…1634]. In the limited studies available, antiviral treatment of persons with symptomatic acute hepatitis C 112 weeks after exposure to HCV resulted in high sustainedresponse rates [6].…”

Section: Replymentioning

confidence: 99%