Treatment of acute hepatitis C infection in HIV-infected patients

Clinicians started to notice the cases of an outbreak of acute hepatitis C (AHC) infections among HIV-positive MSM in Europe almost 10 years ago. Similar reports from the USA and Australia soon followed. In the absence of randomized controlled treatment trials clinicians have to rely on published data from uncontrolled clinical and cohort studies to develop treatment algorithms in these patients and give recommendations on best clinical management.

Data from recent cohort studies indicate that the early course of hepatitis C virus (HCV) RNA in the first 4 weeks after diagnosis may be a helpful predictor of spontaneous clearance of AHC in HIV-infected individuals. Additionally, single-nucleotide polymorphisms near the IL28B gene have been demonstrated to impact chances of spontaneous clearance. Pegylated interferon in combination with weight-adapted ribavirin is recommended as treatment of choice for all HCV genotypes. For patients developing a rapid virological response, defined as a negative HCV-RNA in an ultrasensitive assay, treatment duration of 24 weeks is recommended. Overall, high-sustained virological response rates of 60-80% have been observed if antiviral therapy was initiated within 24 weeks after diagnosis.

The current epidemic of AHC particularly among MSM is still ongoing, and prevention and screening efforts have to be intensified to allow for control of viral dissemination. Concise recommendations for best clinical management of AHC in HIV infection have been developed on the basis of published observational data.