Pharmacological interventions for acute hepatitis C infection

Area of Science:

• Hepatology
• Virology
• Pharmacology

Background:

• Hepatitis C virus (HCV) infection can lead to chronic liver disease.
• Acute HCV infection treatment remains controversial.
• An estimated 160 million people worldwide had chronic HCV infection in 2010.

Purpose of the Study:

• To assess the comparative benefits and harms of pharmacological interventions for acute HCV infection.
• To rank treatments by safety and efficacy.
• To use network meta-analysis for treatment comparison.

Main Methods:

• Searched multiple databases for randomized clinical trials up to April 2016.
• Included trials on acute HCV infection, excluding liver transplant recipients and co-infected patients.
• Assessed risk of bias, controlled random errors with Trial Sequential Analysis, and used GRADE for evidence quality.

Main Results:

• 10 trials with 488 participants were included; all had high risk of bias and very low-quality evidence.
• Interferon-alpha showed a potential benefit in reducing chronic HCV (SVR), but with imprecise estimates.
• Pegylated interferon-alpha plus ribavirin showed more serious adverse events than pegylated interferon-alpha alone.

Conclusions:

• Very low-quality evidence suggests interferon-alpha may decrease chronic HCV incidence.
• Clinical impact on quality of life and liver disease progression is unreported.
• No trials compared direct-acting antivirals for acute HCV; high-quality trials are needed.