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Lancet. 2008 Jul 26;372(9635):321-32.

Acute hepatitis C.

Maheshwari A, Ray S, Thuluvath PJ.

Division of Gastroenterology and Hepatology, s Hopkins University School of

Medicine, Baltimore, MD, USA.

Symptomatic acute hepatitis C occurs in only about 15% of patients who are

infected with hepatitis C virus (HCV). Acute hepatitis C is most often diagnosed

in the setting of post-exposure surveillance, or seroconversion in high-risk

individuals (eg, health-care professionals or injecting drug users) previously

known to be seronegative. Although transmission via transfusion and injecting

drug use has declined in developed countries, unsafe blood products and medical

practices continue to increase transmission of HCV in many developing countries.

Clinically, acute hepatitis C can increase concentrations of alanine

aminotransferase to ten times the upper limit of normal but almost never causes

fulminant hepatic failure. Diagnosis of HCV infection in the acute phase is

difficult since production of antibodies against HCV can be delayed by up to 12

weeks, and about a third of infected individuals might not have detectable

antibody at the onset of symptoms. Therefore, testing for HCV RNA by PCR is the

only reliable test for the diagnosis of acute infection. Symptomatic patients

with jaundice have a higher likelihood of spontaneous viral clearance than do

asymptomatic patients, and thus should be monitored for at least 12 weeks before

initiating antiviral therapy. By contrast, asymptomatic patients have a much

lower chance of spontaneous clearance, and might benefit from early antiviral

therapy. Antiviral therapy for 12 weeks is generally effective in treating

patients who are HCV RNA negative after 4 weeks of treatment; lengthier courses

could be needed for those who relapse or fail to show early virological

clearance.

PMID: 18657711 [PubMed - in process]

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Lancet. 2008 Jul 26;372(9635):321-32.

Acute hepatitis C.

Maheshwari A, Ray S, Thuluvath PJ.

Division of Gastroenterology and Hepatology, s Hopkins University School of

Medicine, Baltimore, MD, USA.

Symptomatic acute hepatitis C occurs in only about 15% of patients who are

infected with hepatitis C virus (HCV). Acute hepatitis C is most often diagnosed

in the setting of post-exposure surveillance, or seroconversion in high-risk

individuals (eg, health-care professionals or injecting drug users) previously

known to be seronegative. Although transmission via transfusion and injecting

drug use has declined in developed countries, unsafe blood products and medical

practices continue to increase transmission of HCV in many developing countries.

Clinically, acute hepatitis C can increase concentrations of alanine

aminotransferase to ten times the upper limit of normal but almost never causes

fulminant hepatic failure. Diagnosis of HCV infection in the acute phase is

difficult since production of antibodies against HCV can be delayed by up to 12

weeks, and about a third of infected individuals might not have detectable

antibody at the onset of symptoms. Therefore, testing for HCV RNA by PCR is the

only reliable test for the diagnosis of acute infection. Symptomatic patients

with jaundice have a higher likelihood of spontaneous viral clearance than do

asymptomatic patients, and thus should be monitored for at least 12 weeks before

initiating antiviral therapy. By contrast, asymptomatic patients have a much

lower chance of spontaneous clearance, and might benefit from early antiviral

therapy. Antiviral therapy for 12 weeks is generally effective in treating

patients who are HCV RNA negative after 4 weeks of treatment; lengthier courses

could be needed for those who relapse or fail to show early virological

clearance.

PMID: 18657711 [PubMed - in process]

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