Symptomatic Acute Hepatitis C in Egypt: Diagnosis, Spontaneous Viral Clearance, and Delayed Treatment with 12 Weeks of Pegylated Interferon Alfa-2a

Department of Community Medicine, Ain Shams University, Cairo, Egypt.
PLoS ONE (Impact Factor: 3.23). 02/2008; 3(12):e4085. DOI: 10.1371/journal.pone.0004085
Source: PubMed

ABSTRACT The aim of this study was to estimate the proportion of spontaneous viral clearance (SVC) after symptomatic acute hepatitis C and to evaluate the efficacy of 12 weeks of pegylated interferon alfa-2a in patients who did not clear the virus spontaneously.
Patients with symptomatic acute hepatitis C were recruited from two "fever hospitals" in Cairo, Egypt. Patients still viremic three months after the onset of symptoms were considered for treatment with 12 weeks of pegylated interferon alfa-2a (180 microg/week).
Between May 2002 and February 2006, 2243 adult patients with acute hepatitis were enrolled in the study. The SVC rate among 117 patients with acute hepatitis C was 33.8% (95%CI [25.9%-43.2%]) at three months and 41.5% (95%CI [33.0%-51.2%]) at six months. The sustained virological response (SVR) rate among the 17 patients who started treatment 4-6 months after onset of symptoms was 15/17 = 88.2% (95%CI [63.6%-98.5%]).
Spontaneous viral clearance was high (41.5% six months after the onset of symptoms) in this population with symptomatic acute hepatitis C. Allowing time for spontaneous clearance should be considered before treatment is initiated for symptomatic acute hepatitis C.

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Available from: Mohamed Abdel-Hamid, Sep 27, 2015
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    • "On the other hand, because relatively few individuals with asymptomatic acute hepatitis C are able to spontaneously clear the virus, in such cases the appropriate treatment should be initiated as soon as possible [18,20]. However, the rate of spontaneous clearance is debatable; some sources indicate that around 31% of symptomatic cases and about 18% of asymptomatic cases are naturally resolved without treatment [18], while others suggest higher figures. A study by Geralch et al., for instance, showed that permanent and spontaneous clearance of the virus was observed in more than 50% of untreated patients with acute symptomatic HCV within the first three to four months after infection [20]. "
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    • "Despite these data, new infections continue to occur by other transmission routes. Geographic differences between risk factors have been reported in studies on acute hepatitis C. Whereas unsafe injection practices by illicit drug users are the main routes of transmission of hepatitis C in the United States and most industrialized countries [Kamal, 2008; Wasley et al., 2008], invasive procedures performed at health services centers have become the most important factor in other regions of the world [Irving et al., 2008; Kamal, 2008; Martínez- Bauer et al., 2008; Santantonio et al., 2008; Sharaf Eldin et al., 2008]. Other routes of transmission reported less frequently are occupational exposure and uncommonly perinatal transmission and sexual contact with virus carriers [Irving et al., 2008; Cox et al., 2009]. "
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    • "Diagnosis of acute HCV infection was based upon previously established criteria [10,11,21]: (1) a positive anti-HCV antibody or HCV RNA result in a patient with a negative anti-HCV test result within the past year, or (2) a positive anti-HCV and HCV RNA result in a patient with clinical hepatitis, ALT levels 10 times the upper limit of normal (32 U/L); or, (3) in absence of detectable HCV RNA, history of high-risk exposure between 1 and 3 months prior to clinical manifestation in anti-HCV seropositive patients. Further details on the diagnosis of acute HCV infection is described elsewhere [20]. "
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