Abstract
Around 25% of people infected with hepatitis C virus (HCV) are able to clear the infection spontaneously, while the majority become chronically infected, with a subsequent risk for the individual patient of progressive inflammatory liver disease, cirrhosis, hepatocellular carcinoma and liver-related death (Figure 1). Much is known about the epidemiology, pathogenesis, diagnosis and management of chronic HCV infection. In comparison, knowledge about acute HCV infection is patchy. In this article, we will highlight concerns relating to acute HCV infection and suggest that public health bodies responsible for managing the HCV epidemic should redirect at least some of their resources to dealing with these issues.
Highlights
Given the largely asymptomatic nature of the acute infection, as well as the fact that most acute infections occur in injecting drug users (IDUs) who are hard to reach, and that a diagnosis of acute infection can be difficult to prove, most studies of the natural history of acute hepatitis C virus (HCV) infection contain relatively few patients
The case definition for acute HCV infection has both clinical and laboratory components – see Table. Note that this case definition will not discriminate between acute infection and an acute exacerbation of chronic infection
The HCV data within the report demonstrate a steady increase in the “Incidence rate of hepatitis C cases in EU and EEA/EFTA countries by year reported 1995-2004”, but this clearly does not relate to incident infection, but to an unspecified amalgam of chronic and acute infections, the bulk of which will be chronic
Summary
Given the largely asymptomatic nature of the acute infection, as well as the fact that most acute infections occur in injecting drug users (IDUs) who are hard to reach, and that a diagnosis of acute infection can be difficult to prove (see below), most studies of the natural history of acute HCV infection contain relatively few patients. These data do not distinguish between acute and chronic infections, and it is highly likely that the vast majority of the reported cases are from patients with chronic infection. In 2006, 802 cases of acute HCV infection were reported, a population incidence of 0.3/100,000.
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