Acute Hepatitis C: A Systematic Review

Department of Gastroenterology and Liver Disease, Ain Shams Faculty of Medicine, Cairo, Egypt.
The American Journal of Gastroenterology (Impact Factor: 10.76). 06/2008; 103(5):1283-97; quiz 1298. DOI: 10.1111/j.1572-0241.2008.01825.x
Source: PubMed


The annual incidence of acute hepatitis C virus (HCV) has fallen in recent years, primarily because of effective blood screening efforts and increased education on the dangers of needle sharing. However, hepatitis C infection is still relatively frequent in certain populations. Most patients infected with HCV are unaware of their exposure and remain asymptomatic during the initial stages of the infection, making early diagnosis during the acute phase (first 6 months after infection) unlikely. While some of those infections will have a spontaneous resolution, the majority will progress to chronic HCV. We scanned the literature for predictors of spontaneous resolution and treatment during the acute stage of HCV to identify factors that would assist in treatment decision making.
A medical literature search through MEDLINE was conducted using the keyword "acute hepatitis C" with a variety of keywords focused on (a) epidemiology, (b) natural history and outcome, (c) diagnosis, (d) mode of transmission, and (e) treatment.
There are no reliable predictors for spontaneous resolution of HCV infection and a significant percentage of individuals exposed to HCV develop persistent infections that progress to chronic liver disease. An intriguing approach is to treat acute HCV and prevent the development of chronic hepatitis. Several clinical trials showed that treatment of hepatitis C infection during the acute phase is associated with high sustained virological response (SVR) rates ranging between 75% and 100%. Although there is a prevailing consensus that intervention during the acute phase is associated with improved viral eradication, relevant clinical questions have remained unanswered by clinical trials. Optimization of therapy for acute hepatitis C infection and identification of predictors of SVR represent a real challenge.
With more than 170 million chronic hepatitis C patients worldwide and an increase in the related morbidity and mortality projected for the next decade, an improvement in our ability to diagnose and treat patients with acute hepatitis C would have a significant impact on the prevalence of chronic hepatitis and its associated complications particularly in countries with a high endemic background of the infection.

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    • "Most of newly infected persons are asymptomatic (and are unaware of their infection) with a minority having symptoms such as jaundice, dark urine, fatigue, nausea, vomiting, and abdominal pain [6]. Approximately 10-20% spontaneously clear the virus and develop natural immunity. "

    Full-text · Article · Jan 2015
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    • "Education could thus also increase HCV screening for individuals with acute HCV. Early treatment uptake is important because the spontaneous clearance rate is limited and, in contrast with chronic HCV, treatment of acute HCV leads to much higher clearance rates102 within a shorter period of time.17,103 This also applies to PWID.82 "
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    ABSTRACT: Hepatitis C virus (HCV) infections are highly prevalent amongst people who inject drugs (PWID). Despite well documented evidence of its effectiveness, suggested cost-effectiveness, and potential to reduce HCV prevalence rates, the uptake of antiviral HCV treatment by PWID is low. This nonsystematic literature review describes factors associated with the uptake, adherence, and efficacy of HCV treatment among PWID and discusses strategies to increase their uptake of treatment. Low HCV treatment uptake among PWID is associated with a number of patient-related and provider-related barriers. Beliefs and fears about low efficacy and adverse effects on the patient's part are common. A substantial number of factors are associated with the chaotic lifestyle and altered social functioning of PWID, which are often associated with decompensation or relapsing into drug addiction. This may lead to perceived low adherence with treatment and low efficacy on the provider's part too, where lack of support, inadequate management of addiction, and other drug-related problems and poor treatment of side effects have been described. Practical issues such as the accessibility of treatment and finances also play a role. Strategies to improve the HCV treatment rate among PWID involve pretreatment management and assessment, a multidisciplinary approach, management of side effects, and enhanced education and counseling. Specific factors are associated with poorer treatment outcomes in PWID on the side of both the patient and the treatment system. However, given that PWID can achieve treatment adherence and sustained virologic response rates comparable with those in nondrug users, drug use per se should not be considered a criterion for exclusion from treatment. Further development of measures leading to higher uptake of treatment and adherence in PWID and appropriate adaptation of HCV treatment guidelines represent important tools in this regard.
    Full-text · Article · Oct 2013 · Patient Preference and Adherence
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    • "While some studies showed higher HCV incidence among men, other population based surveys showed slightly higher rates in women than in men. However, additional epidemiological studies are needed to confirm that the risk of HCV transmission is greater in men [14]. In this study, seroprevalence was higher in females, 24 (1.01%). "
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    ABSTRACT: Background. Hepatitis C virus (HCV) represents a major worldwide public health problem. Though several studies from Yemen have provided an estimate of the prevalence of this viral infection, there exist only few studies which reflect the status in the general population. Aim. The present study was designed to investigate the prevalence of hepatitis C infection among general population in central region of Yemen. Methods. The study population comprised 2,379 apparently healthy subjects who were screened for hepatitis C antibodies (HCV Abs) status using ELISA quantitative technique. Seroprevalence rate of seropositive subjects was calculated and stratified by age, sex, educational level, and monthly income. Results. The study showed that out of 2,379 subjects, 31 (1.3%) were HCV Abs positive. Higher prevalence of HCV Abs was found among females, 24 (1.01%), than males, 7 (0.29%). The age specific prevalence rose from 00 (0.00%) in subjects aged ≤14 years to a maximum of 9 (0.38%) in subjects aged ≥55 years. The prevalence of HCV Abs was more prevalent in illiterate subjects and increased with decreasing monthly income. Conclusion. It was found that variables including age and educational level were significantly associated with HCV Ab positivity and not associated with gender and monthly income.
    Full-text · Article · Dec 2012 · Hepatitis research and treatment
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