December 19, 2014
Although hepatitis C (HCV) infection can be treated and cured, a leading clinician cautioned this week that health care providers should not start treatment too soon after infection, because some patients may not need medications at all.
On Dec. 16, the International Viral Society-USA hosted a webinar entitled "Management of Acute HCV Infection," featuring Arthur Y. Kim, M.D., the director of the Viral Hepatitis Clinic at Massachusetts General Hospital. Kim explained that most studies define acute HCV as occurring during the first 6 months after initial infection. During that time, he said, about 20% of HCV-positive patients will clear the infection on their own.
The response to interferon-based HCV treatment is better during the acute period than at later points, Kim admitted. However, during these first 24 weeks alanine aminotransferase levels tends to oscillate between normal and elevated. As a result, the infection may not be diagnosed, if the patient is tested while at the normal level.
If someone seroconverts while ill or has an acute illness consistent with acute HCV, a definitive diagnosis is possible. A highly probable diagnosis is based on patient behavior, such as recent onset of injection drug use or starting to share needles, Kim said. Targeted screening prior to HCV testing should therefore include a history of patient behavior, including any recent changes, he suggested.
Because of the relatively high rate of spontaneous clearance of HCV, a waiting period of at least 12 weeks after initial exposure is recommended before initiating treatment, Kim said. An even longer waiting period may be indicated since "any treatment for HCV in acute phase is off label," Kim added. Patients' HCV RNA should be monitored during that time, however.
Kim also noted that sexual transmission of HCV is significantly more likely in HIV-infected men who have sex with men than in heterosexual couples. He called the intersection of sex, drugs and HIV in the lives of some men "the perfect storm for sexual HCV transmission," citing the example of men who may have a compromised immune system due to HIV and who, after using crystal methamphetamine, engage in sexual practices that cause trauma to the rectal mucosa (or other higher-risk sex).
Still, most new HCV infections occur among injection drug users (IDUs), Kim said. Contrary to popular misconceptions, the majority of IDUs in the U.S. who are newly infected with hepatitis C are white and do not live in large cities, he noted.
Barbara Jungwirth is a freelance writer and translator based in New York.
Follow Barbara on Twitter: @reliabletran.
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