Skip to main content
SpringerLink
Log in

Acute HCV

  • Chapter
  • First Online:
Chronic Hepatitis C Virus

  • 1065 Accesses

Abstract

The rate of chronic evolution in patients with acute hepatitis C is 50–90%. Chronicity is associated with the risk to develop hepatic decompensation and hepatocellular carcinoma. Fortunately, it has been shown that the initiation of interferon monotherapy during acute phase of hepatitis C virus infection significantly reduces evolution to chronic hepatitis. Immediate treatment of acute HCV infection within 2–3 months after infection led to 98% of sustained virological response in the pivotal trial using recombinant IFN-alfa-2b and to sustained virological response rates between 84 and 89% using PEG-IFN-alfa-2b for 6 months in subsequent trials. The results of the major trials showed that there is no need for a combination with ribavirin.

Early immediate treatment with PEG-IFNa-2b is highly effective in both symptomatic and asymptomatic patients. Delayed IFNa + ribavirin treatment resulted in lower overall response rates; however, if adherence can be assured this strategy seems to be of similar efficacy in symptomatic patients. The main aim in the management of acute hepatitis C is to find a balance between unnecessary overtreatment of patients who might clear the infection spontaneously and on the other hand to avoid chronicity of hepatitis C infection. In addition, the optimal management of patients with acute hepatitis C infection should include a careful workup of clinical and virological data as well as the consideration of the individual patient’s history.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wedemeyer H, Jackel E, Wiegand J, Cornberg M, Manns MP. Whom? When? How? Another piece of evidence for early treatment of acute hepatitis C. Hepatology. 2004;39:1201–3.

    Article  PubMed  Google Scholar 

  2. Mele A, Tosti ME, Marzolini A, Moiraghi A, Ragni P, Gallo G, et al. Prevention of hepatitis C in Italy: lessons from surveillance of type-specific acute viral hepatitis. SEIEVA collaborating Group. J Viral Hepat. 2000;7:30–5.

    Article  PubMed  CAS  Google Scholar 

  3. Tosti ME, Solinas S, Prati D, Salvaneschi L, Manca M, Francesconi M, et al. An estimate of the current risk of transmitting blood-borne infections through blood transfusion in Italy. Br J Haematol. 2002;117:215–9.

    Article  PubMed  CAS  Google Scholar 

  4. Kondili LA, Chionne P, Costantino A, Villano U, Lo NC, Pannozzo F, et al. Infection rate and spontaneous seroreversion of anti-hepatitis C virus during the natural course of hepatitis C virus infection in the general population. Gut. 2002;50:693–6.

    Article  PubMed  CAS  Google Scholar 

  5. Roy K, Hay G, Andragetti R, Taylor A, Goldberg D, Wiessing L. Monitoring hepatitis C virus infection among injecting drug users in the European Union: a review of the literature. Epidemiol Infect. 2002;129:577–85.

    Article  PubMed  CAS  Google Scholar 

  6. Broers B, Helbling B, Francois A, Schmid P, Chuard C, Hadengue A, et al. Barriers to interferon-alpha therapy are higher in intravenous drug users than in other patients with acute hepatitis C. J Hepatol. 2005;42:323–8.

    Article  PubMed  CAS  Google Scholar 

  7. De Rosa FG, Bargiacchi O, Audagnotto S, Garazzino S, Cariti G, Veronese L, et al. The early HCV RNA dynamics in patients with acute hepatitis C treated with pegylated interferon-alpha2b. Antivir Ther. 2006;11:165–71.

    PubMed  Google Scholar 

  8. Deterding K, Wiegand J, Gruner N, Wedemeyer H. Medical procedures as a risk factor for HCV infection in developed countries: do we neglect a significant problem in medical care? J Hepatol. 2008;48:1019–20.

    Article  PubMed  Google Scholar 

  9. Santantonio T, Medda E, Ferrari C, Fabris P, Cariti G, Massari M, et al. Risk factors and outcome among a large patient cohort with community-acquired acute hepatitis C in Italy. Clin Infect Dis. 2006;43:1154–9.

    Article  PubMed  CAS  Google Scholar 

  10. Prati D. Transmission of hepatitis C virus by blood transfusions and other medical procedures: a global review. J Hepatol. 2006;45:607–16.

    Article  PubMed  Google Scholar 

  11. Marti Nez-Bauer E, Forns X, Armelles M, Planas R, Sola R, Vergara M, et al. Hospital admission is a relevant source of hepatitis C virus acquisition in Spain. J Hepatol. 2008;48(1):20–7.

    Article  Google Scholar 

  12. Kubitschke A, Bader C, Tillmann HL, Manns MP, Kuhn S, Wedemeyer H. Injuries from needles contaminated with hepatitis C virus: how high is the risk of seroconversion for medical personnel really? Internist (Berl). 2007;48:1165–72.

    Article  CAS  Google Scholar 

  13. Bertoletti A, Ferrari C. Kinetics of the immune response during HBV and HCV infection. Hepatology. 2003;38:4–13.

    Article  PubMed  CAS  Google Scholar 

  14. Alter MJ, Margolis HS, Krawczynski K, Judson FN, Mares A, Alexander WJ, et al. The natural history of community-acquired hepatitis C in the United States. The Sentinel Counties Chronic non-A, non-B Hepatitis Study Team. N Engl J Med. 1992;327:1899–905.

    Article  PubMed  CAS  Google Scholar 

  15. Santantonio T, Sinisi E, Guastadisegni A, Casalino C, Mazzola M, Gentile A, et al. Natural course of acute hepatitis C: a long-term prospective study. Dig Liver Dis. 2003;35:104–13.

    Article  PubMed  CAS  Google Scholar 

  16. Lehmann M, Meyer MF, Monazahian M, Tillmann HL, Manns MP, Wedemeyer H. High rate of spontaneous clearance of acute hepatitis C virus genotype 3 infection. J Med Virol. 2004;73:387–91.

    Article  PubMed  Google Scholar 

  17. Wiegand J, Buggisch P, Boecher W, Zeuzem S, Gelbmann CM, Berg T, et al. Early monotherapy with pegylated interferon alpha-2b for acute hepatitis C infection: the HEP-NET acute-HCV-II study. Hepatology. 2006;43:250–6.

    Article  PubMed  CAS  Google Scholar 

  18. Viladomiu L, Genesca J, Esteban JI, Allende H, Gonzalez A, Lopez-Talavera JC, et al. Interferon-alpha in acute posttransfusion hepatitis C: a randomized, controlled trial. Hepatology. 1992;15:767–9.

    Article  PubMed  CAS  Google Scholar 

  19. Hwang SJ, Lee SD, Chan CY, Lu RH, Lo KJ. A randomized controlled trial of recombinant interferon alpha-2b in the treatment of Chinese patients with acute post-transfusion hepatitis C. J Hepatol. 1994;21:831–6.

    Article  PubMed  CAS  Google Scholar 

  20. Lampertico P, Rumi M, Romeo R, Craxi A, Soffredini R, Biassoni D, et al. A multicenter randomized controlled trial of recombinant interferon-alpha 2b in patients with acute transfusion-associated hepatitis C. Hepatology. 1994;19:19–22.

    Article  PubMed  CAS  Google Scholar 

  21. Calleri G, Colombatto P, Gozzelino M, Chieppa F, Romano P, Delmastro B, et al. Natural beta interferon in acute type-C hepatitis patients: a randomized controlled trial. Ital J Gastroenterol Hepatol. 1998;30:181–4.

    PubMed  CAS  Google Scholar 

  22. Omata M, Yokosuka O, Takano S, Kato N, Hosoda K, Imazeki F, et al. Resolution of acute hepatitis C after therapy with natural beta interferon. Lancet. 1991;338:914–5.

    Article  PubMed  CAS  Google Scholar 

  23. Ohnishi K, Nomura F, Nakano M. Interferon therapy for acute posttransfusion non-A, non-B hepatitis: response with respect to anti-hepatitis C virus antibody status. Am J Gastroenterol. 1991;86:1041–9.

    PubMed  CAS  Google Scholar 

  24. Vogel W, Graziadei I, Umlauft F, Datz C, Hackl F, Allinger S, et al. High-dose interferon-alpha2b treatment prevents chronicity in acute hepatitis C: a pilot study. Dig Dis Sci. 1996;41:81S–5.

    Article  PubMed  CAS  Google Scholar 

  25. Jäeckel E, Cornberg M, Wedemeyer H, Santantonio T, Mayer J, Zankel M, et al. Treatment of acute hepatitis C with interferon alfa-2b. N Engl J Med. 2001;345:1452–7.

    Article  PubMed  Google Scholar 

  26. Wiegand J, Jackel E, Cornberg M, Hinrichsen H, Dietrich M, Kroeger J, et al. Long-term follow-up after successful interferon therapy of acute hepatitis C. Hepatology. 2004;40:98–107.

    Article  PubMed  CAS  Google Scholar 

  27. Delwaide J, Bourgeois N, Gerard C, De Maeght S, Mokaddem F, Wain E, et al. Treatment of acute hepatitis C with interferon alpha-2b: early initiation of treatment is the most effective predictive factor of sustained viral response. Aliment Pharmacol Ther. 2004;20:15–22.

    Article  PubMed  CAS  Google Scholar 

  28. Nomura H, Sou S, Tanimoto H, Nagahama T, Kimura Y, Hayashi J, et al. Short-term interferon-alfa therapy for acute hepatitis C: a randomized controlled trial. Hepatology. 2004;39:1213–9.

    Article  PubMed  CAS  Google Scholar 

  29. Santantonio T, Fasano M, Sinisi E, Guastadisegni A, Casalino C, Mazzola M, et al. Efficacy of a 24-week course of PEG-interferon alpha-2b monotherapy in patients with acute hepatitis C after failure of spontaneous clearance. J Hepatol. 2005;42:329–33.

    Article  PubMed  CAS  Google Scholar 

  30. Manns MP, Meyer S, Wedemeyer H. The German network of excellence for viral hepatitis (Hep-Net). Hepatology. 2003;38:543–4.

    Article  PubMed  Google Scholar 

  31. De Rosa FG, Bargiacchi O, Audagnotto S, Garazzino S, Cariti G, Raiteri R, et al. Dose-dependent and genotype-independent sustained virological response of a 12 week pegylated interferon alpha-2b treatment for acute hepatitis C. J Antimicrob Chemother. 2006;57:360–3.

    Article  PubMed  Google Scholar 

  32. Gerlach JT, Diepolder HM, Zachoval R, Gruener NH, Jung MC, Ulsenheimer A, et al. Acute hepatitis C: high rate of both spontaneous and treatment-induced viral clearance. Gastroenterology. 2003;125:80–8.

    Article  PubMed  Google Scholar 

  33. Deterding K, Grüner N, Wiegand J, Buggisch P, Galle P, Spengler U, et al. Early versus delayed treatment of acute hepatitis C: The German HEP-NET acute HCV-III study-a randomized controlled trial. J Hepatol. 2009;50:380.

    Article  Google Scholar 

  34. Hofer H, Watkins-Riedel T, Janata O, Penner E, Holzmann H, Steindl-Munda P, et al. Spontaneous viral clearance in patients with acute hepatitis C can be predicted by repeated measurements of serum viral load. Hepatology. 2003;37:60–4.

    Article  PubMed  Google Scholar 

  35. Diepolder HM, Zachoval R, Hoffmann RM, Wierenga EA, Santantonio T, Jung MC, et al. Possible mechanism involving T-lymphocyte response to non-structural protein 3 in viral clearance in acute hepatitis C virus infection. Lancet. 1995;346:1006–7.

    Article  PubMed  CAS  Google Scholar 

  36. Rehermann B, Nascimbeni M. Immunology of hepatitis B virus and hepatitis C virus infection. Nat Rev Immunol. 2005;5:215–29.

    Article  PubMed  CAS  Google Scholar 

  37. Takaki A, Wiese M, Maertens G, Depla E, Seifert U, Liebetrau A, et al. Cellular immune responses persist and humoral responses decrease two decades after recovery from a single-source outbreak of hepatitis C. Nat Med. 2000;6:578–82.

    Article  PubMed  CAS  Google Scholar 

  38. Chang KM, Thimme R, Melpolder JJ, Oldach D, Pemberton J, Moorhead-Loudis J, et al. Differential CD4(+) and CD8(+) T-cell responsiveness in hepatitis C virus infection. Hepatology. 2001;33:267–76.

    Article  PubMed  CAS  Google Scholar 

  39. Kubitschke A, Bahr MJ, Aslan N, Bader C, Tillmann HL, Sarrazin C, et al. Induction of hepatitis C virus (HCV)-specific T cells by needle stick injury in the absence of HCV-viraemia. Eur J Clin Invest. 2007;37:54–64.

    Article  PubMed  CAS  Google Scholar 

  40. Tester I, Smyk-Pearson S, Wang P, Wertheimer A, Yao E, Lewinsohn DM, et al. Immune evasion versus recovery after acute hepatitis C virus infection from a shared source. J Exp Med. 2005;201:1725–31.

    Article  PubMed  CAS  Google Scholar 

  41. Rahman F, Heller T, Sobao Y, Mizukoshi E, Nascimbeni M, Alter H, et al. Effects of antiviral therapy on the cellular immune response in acute hepatitis C. Hepatology. 2004;40:87–97.

    Article  PubMed  CAS  Google Scholar 

  42. Lauer GM, Lucas M, Timm J, Ouchi K, Kim AY, Day CL, et al. Full-breadth analysis of CD8+ T-cell responses in acute hepatitis C virus infection and early therapy. J Virol. 2005;79:12979–88.

    Article  PubMed  CAS  Google Scholar 

  43. Wiegand J, Cornberg M, Aslan N, Schlaphoff V, Sarrazin C, Kubitschke A, et al. Fate and function of hepatitis-C-virus-specific T-cells during peginterferon-alpha2b therapy for acute hepatitis C. Antivir Ther. 2007;12:303–16.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, 30625, Germany

    Katja Deterding MD & Michael P. Manns MD

  2. Department of Gastroenterology, Hannover Medical School, Hannover, Germany

    Heiner Wedemeyer MD

Authors
  1. Katja Deterding MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heiner Wedemeyer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael P. Manns MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael P. Manns MD .

Editor information

Editors and Affiliations

  1. Bon Secours Health System, Liver Institute of Virginia, McManus Blvd., Suite 313 12720, Newport News, 23602, Virginia, USA

    Mitchell L. Shiffman

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Deterding, K., Wedemeyer, H., Manns, M.P. (2012). Acute HCV. In: Shiffman, M. (eds) Chronic Hepatitis C Virus. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-1192-5_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-1192-5_2

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-1191-8

  • Online ISBN: 978-1-4614-1192-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation