Looking for an End to the Waiting Game in Acute HCV

Somewhere between one-quarter and one-half of acute hepatitis C infections clear spontaneously, usually within 6 months, depending on the population or cohort. Accordingly, the authors of the joint American Association for the Study of Liver Diseases and Infectious Diseases Society of America HCV guidelines recommend a watching and waiting strategy for patients with recent or acute disease. The societies adopted this approach in the interferon era, when treatment was often more complicated and toxic than the disease itself, particularly for patients with no symptoms. But now that patients can be treated with direct-acting antivirals effectively and largely without incident, that approach may be outdated.

Katja Deterding, MD, of HepNet Study-House and the Hannover Medical School in Hannover, Germany, and colleagues presented a paper on acute HCV at the International Liver Congress in April that drew some attention. The study involved 20 patients with symptomatic acute HCV accrued during 2014 and 2015. There were 11 patients with genotype 1a disease and nine patients with genotype 1b. All patients completed 6 weeks of ledipasvir/sofosbuvir (Harvoni, Gilead Sciences) treatment and 12 weeks of follow-up.

“After only 2 weeks of treatment, already nine patients had undetectable HCV RNA,” Deterding said in her presentation. She added that by week 4 of treatment, HCV RNA was below 15 IU/mL for all 20 patients. “After 6 weeks of treatment, all patients had undetectable HCV RNA.”

Although higher baseline viral load was associated with a slight delay in virological response, follow-up results indicated a 100% SVR12 rate, according to Deterding. “So 6 weeks of antiviral treatment was enough for all patients to clear the acute HCV infection,” she said. As with most DAA therapies, the regimen was well-tolerated.

These findings, then, provide a compelling jumpstart to the discussion of whether the clinical community should consider treating patients with acute infection.

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