Treatment of acute hepatitis C in HIV infection

Abstract

Within Europe and recently in the USA and Australia an ongoing epidemic of acute hepatitis C virus (HCV) infections among HIV-positive individuals, mainly men who have sex with men, has been observed. Other concomitant sexually transmitted diseases and sexual practices with a high risk of mucosal trauma and damage have been established as risk factors for sexual transmission. In HIV-positive patients the diagnosis of acute HCV infection may be obscured by delayed anti-HCV antibody seroconversion, and HCV RNA testing may be warranted. It is estimated that up to 85% of HIV-positive patients take a chronic course after acute HCV infection, and early treatment of acute HCV infection within 12 weeks after the presumed date of infection is recommended unless spontaneous clearance of HCV has occurred. A watch and wait strategy for 4-8 weeks after the date of diagnosis with 4 weekly HCV RNA controls may help to distinguish patients who will spontaneously clear acute HCV infection from those who will not. Treatment of acute HCV infection with interferon-based therapy has been shown to be highly efficacious, with sustained virological response rates in between 60% and 70% of HIV-positive individuals. Though data are sparse, controlling treatment response at weeks 4 and 12 may further help to individualize therapy, and patients who have not reached a negative HCV RNA by week 12 may benefit from prolonged treatment beyond 24 weeks.