::: HCV News :::

By Liz Highleyman

Past studies have shown that treatment of acute hepatitis C virus (HCV) infection is highly successful; a German study published in 2001, for example, found a sustained virological response (SVR) rate of 98% using conventional interferon monotherapy (Jaeckl 2001). However, many individuals with acute infection will clear HCV spontaneously, so if therapy is started too soon, there is a risk of treating patients who don't need it.

In the May 2006 issue of Hepatology, researchers reported on a study looking at the optimal duration of treatment for acute hepatitis C. The study initially evaluated 161 patients, of whom 30 refused treatment and 29 experienced spontaneous HCV clearance. The remaining 102 patients with persistent HCV were randomly assigned to 1.5 mcg weekly pegylated interferon alpha-2b (Peg-Intron) monotherapy for 8, 12, or 24 weeks.

Results Using an intent-to-treat analysis, 67.6% patients who received treatment for 8 weeks achieved SVR; the rate was 82.4% after 12 weeks and 91.2% after 24 weeks. All patients had undetectable HCV RNA 48 weeks after the end of therapy. Treatment for 8 or 12 weeks was effective for patients with HCV genotypes 2, 3, or 4, but those with genotype 1 required 24 weeks. Fewer adverse events were observed in patients receiving treatment for 8 or 12 weeks, compared with the 24-week group.

Conclusion

The authors concluded that pegylated interferon monotherapy "effectively induces high sustained virologic response rates in patients with acute hepatitis C virus infection, thus preventing development of chronic hepatitis C." They suggested that treatment duration should be further optimized based on genotype and rapid virological response at week 4.

Treating Acute HCV in Prison

The Hepatology study, and another recent study of HIV/HCV coinfected patients reported in the May 12, 2006 issue of AIDS, demonstrate that treatment of acute hepatitis C can be effective. However, many people with acute HCV infection do not experience symptoms, and most cases of hepatitis C are not identified at this stage.

A study reported in the June 15 issue of Clinical Infectious Diseases suggests that prisons and drug detoxification and treatment center may be appropriate settings for detecting and treating acute HCV infection among injection drug users.

In this study, on-site medical providers at prisons and detox facilities were educated about risk factors for and symptoms of hepatitis, and asked to refer all potential cases to a specialty clinic.

Results During 30 months of observation, 21 individuals were diagnosed with acute hepatitis C, 3 with hepatitis B, and 1 with hepatitis A. Of the 21 patients with acute hepatitis C, 19 were identified in prison shortly after incarceration. Among 17 hepatitis C patients who received follow-up (for a mean 6.3 months), 8 experienced spontaneous HCV clearance. 5 patients with persistent HCV were treated with pegylated interferon monotherapy; 2 of these (40%) achieved SVR. All patients agreed to receive HIV counseling and testing, as well as immunization against hepatitis A and B.

Conclusion

The authors concluded that, "Incarceration presents a unique opportunity to identify injection drug users with acute HCV infection, to initiate counseling regarding other blood-borne pathogens, and to facilitate immunizations and HCV treatment."

6/20/06

References

SM Kamal, KN Moustafa, J Chen, and others. Duration of peginterferon therapy in acute hepatitis C: a randomized trial. Hepatology. 43(5): 923-931. May 2006.

BH McGovern, A Wurcel, AY Kim, and others. Acute hepatitis C virus infection in incarcerated injection drug users. Clin Infect Dis. 42(12): 1663-1670. June 15, 2006.

E Jaeckel, M Cornberg, H. Wedemeyer, and others. Treatment of acute hepatitis C with interferon Alfa-2b. New England J Med. 345: 1452-1457. November 15, 2001.

Source: http://www.hivandhepatitis.com
Link: http://www.hivandhepatitis.com/hep_c/news/2006/062006_a.html