Acute Hepatitis C: A Systematic Review

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http://www.blackwell-synergy.com/doi/abs/10.1111/j.1572-0241.2008.01825.x

The American Journal of Gastroenterology 103 (5) , 1283–1297

doi:10.1111/j.1572-0241.2008.01825.x

Abstract

CLINICAL REVIEWS

Acute Hepatitis C: A Systematic Review

CME

Sanaa M. Kamal, M.D., Ph.D.11Department of Gastroenterology and Liver Disease,

Ain Shams Faculty of Medicine, Cairo, Egypt1Department of Gastroenterology and

Liver Disease, Ain Shams Faculty of Medicine, Cairo, Egypt

Reprint requests and correspondence: Dr. Sanaa M. Kamal, Department of

Gastroenterology and Liver Diseases, Ain Shams University, 22 Al Ahram Street,

Cairo, Egypt.

To access a continuing medical education exam for this article, please visit

http://www.acg.gi.org/journalcme.

(Am J Gastroenterol 2008;103:1283–1297)

Abstract

INTRODUCTION: 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.

METHODS: A medical literature search through MEDLINE was conducted using the

keyword " acute hepatitis C " with a variety of keywords focused on (a)

epidemiology, ( natural history and outcome, © diagnosis, (d) mode of

transmission, and (e) treatment.

RESULTS: 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.

CONCLUSION: 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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[Guest guest]

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1572-0241.2008.01825.x

The American Journal of Gastroenterology 103 (5) , 1283–1297

doi:10.1111/j.1572-0241.2008.01825.x

Abstract

CLINICAL REVIEWS

Acute Hepatitis C: A Systematic Review

CME

Sanaa M. Kamal, M.D., Ph.D.11Department of Gastroenterology and Liver Disease,

Ain Shams Faculty of Medicine, Cairo, Egypt1Department of Gastroenterology and

Liver Disease, Ain Shams Faculty of Medicine, Cairo, Egypt

Reprint requests and correspondence: Dr. Sanaa M. Kamal, Department of

Gastroenterology and Liver Diseases, Ain Shams University, 22 Al Ahram Street,

Cairo, Egypt.

To access a continuing medical education exam for this article, please visit

http://www.acg.gi.org/journalcme.

(Am J Gastroenterol 2008;103:1283–1297)

Abstract

INTRODUCTION: 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.

METHODS: A medical literature search through MEDLINE was conducted using the

keyword " acute hepatitis C " with a variety of keywords focused on (a)

epidemiology, ( natural history and outcome, © diagnosis, (d) mode of

transmission, and (e) treatment.

RESULTS: 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.

CONCLUSION: 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.

_________________________________________________________________

Stay in touch when you're away with Windows Live Messenger.

http://www.windowslive.com/messenger/overview.html?ocid=TXT_TAGLM_WL_Refresh_mes\

senger_052008