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Natural course of acute hepatitis C: a long-term prospective study
T Santantonio1, E Sinisi, A Guastadisegni
1Department of Clinical Medicine, Immunology and Infectious Diseases, University of Bari, Bari, Italy. t.santantonio@clininf.uniba.it
Insights
About 30% of patients with acute hepatitis C (AHC) experience spontaneous resolution. Early antiviral treatment is recommended for those with persistent viremia or jaundice beyond 12 weeks to prevent chronic hepatitis C.
Area of Science:
- Hepatology
- Virology
- Infectious Diseases
Background:
- Acute hepatitis C (AHC) often leads to chronic infection.
- Early antiviral treatment may reduce AHC chronicity.
- Optimal timing and patient selection for AHC treatment remain unclear.
Purpose of the Study:
- To investigate the natural course of AHC.
- To determine the rate of spontaneous resolution and chronicity.
- To identify host and viral factors predicting AHC outcomes.
Main Methods:
- Prospective study of 40 consecutive patients with community-acquired AHC (1995-2000).
- Monitoring of liver tests, anti-HCV antibodies, and HCV RNA levels.
- Median follow-up of 35 months.
Main Results:
- 24/40 patients had symptomatic AHC, with 20 experiencing jaundice.
- 13/40 patients achieved spontaneous viral clearance and normalized ALT within 12 weeks.
- Older age and jaundice predicted resolution; persistent viremia (>12 weeks) and anicteric disease predicted chronicity.
Conclusions:
- Spontaneous resolution occurs in approximately 30% of AHC patients.
- Favorable spontaneous resolution is uncommon in anicteric AHC or with persistent viremia.
- Early antiviral therapy is suggested for AHC patients unlikely to resolve spontaneously to prevent chronicity.
Background:
Acute hepatitis C has a high chronicity rate which appears to be significantly reduced by early antiviral treatment. However, it is unclear if all acutely infected patients should be treated, and when. In this prospective study, patients with a well-documented diagnosis of acute hepatitis C were evaluated to define the natural course, the rate of chronicity, and host and virus-related factors which might predict a self-limiting or chronic evolution requiring early antiviral treatment.
Methods:
From 1995 to 2000, 40 consecutive patients with a community-acquired AHC were enrolled. Liver tests, anti-hepatitis C virus antibodies and hepatitis C virus RNA levels were monitored. Median follow-up was 35 months (range 12-68).
Results:
A total of 24/40 patients had symptomatic disease including 20 with jaundice; 13/40 patients had prompt serum hepatitis C virus RNA clearance and ALT normalisation within 12 weeks; in 12/13 patients this pattern remained unchanged during follow-up. Overall, 27/40 patients remained hepatitis C virus RNA positive with fluctuating ALT levels. Older age and jaundice were predictive of resolution whereas there was no correlation with other host factors, viral genotype or viral load.
Conclusions:
Our data demonstrate that spontaneous resolution can occur in about 30% of AHC patients. This favourable outcome rarely occurs in patients with anicteric AHC or in those with jaundice but with persistent viremia for more than 12 weeks from onset; early antiviral treatment for these patients may avoid or reduce chronicity.