If and When to Treat Acute Hepatitis C

The high cure rate associated with new drugs approved to treat chronic hepatitis C has stirred debate about the relevance of early diagnosis and treatment of the acute stage of this infectious liver disease.

The high cure rate associated with new drugs approved to treat chronic hepatitis C has stirred debate about the relevance of early diagnosis and treatment of this infectious liver disease.

During his presentation on whether acute hepatitis C is still important to diagnose and treat, Arthur Kim, MD, director of the Viral Hepatitis Clinic at Massachusetts General Hospital, noted that it’s possible that hepatitis C is more transmissible during the virus’s acute phase than when the infection becomes chronic. Kim was a presenter at the 2015 Conference on Retroviruses and Opportunistic Infections held this week in Seattle, WA.

When considering use of new interferon-free drugs to treat hepatitis C, some in the medical and scientific field have adopted an attitude of “We’ll deal with them later when they’ve entered chronic infection,” Kim said.

Any mention of antiviral treatment of acute hepatitis C is by definition considered “off label” because direct acting agents, which have been so successful in the past year, are approved only for the chronic phase of the disease, Kim said. Most studies define acute hepatitis C as the first 6 months of infection, which is also the period during which the chance of spontaneous clearance of the virus is typically the highest.

“So if one is going to clear, that is the time when it’s going to happen,” he said. That is also the time when most patients respond best to interferon-based treatment, he added.

Kim presented a case study about a young woman newly diagnosed with the virus who also was an injection drug user. He solicited suggestions from the audience about how to counsel herabout the disease.

Advice from others in attendance included telling the patient that sharing needles as well as drug paraphernalia can transmit the disease and cautioning her not to share her razor or toothbrush. Making sure her sexual partner gets regularly screened for the virus was also advised.

While it’s “not quite inevitable,” there are a huge number of injection drug users who acquire hepatitis C virus, Kim said. He noted that though the virus can last for a while on some surfaces it seems particularly adaptive on the inside of needles and syringes.

In the last 20 years there has been a five-fold increase in the use of prescription opioid medications throughout the country, Kim said. He presented data indicating that heroin use, in particular, among Americans skyrocketed in a 10-year period, with about 669,000 people reporting use of the drug in 2012 compared to 404,000 10 years earlier.

Those staggering numbers are connected to an increased risk of new cases of hepatitis C because health officials say that today the disease is most frequently passed from one injection drug user to another through use of tainted needles and other drug paraphernalia. Given the huge increase in opioid use, Kim said the epidemic of hepatitis C is not surprising.

He concluded his presentation by describing acute hepatitis C as an iceberg. Only the tip is visible because of asymptomatic or minimally symptomatic transmission, he said. “Whether it’s in your HIV clinics in Europe, whether it’s the suburbs in your area of the United States... I think it’s still important to diagnose and treat.”