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    NATAP - www.natap.org ... AASLD Dallas, Nov 9-13 Reported by Jules Levin see NATAP website for ongoing AASLD reporting Abstract 676. ACUTE HEPATITIS C: NATURAL
    Message 1 of 1 , Nov 27, 2001
      NATAP - www.natap.org

      Dallas, Nov 9-13
      Reported by Jules Levin
      see NATAP website for ongoing AASLD reporting


      Tilman J Gerlach, Reinhart Zachoval, Norbert Gruener,
      Maria-Christina Jung, Klinikum Grosshadern Med Dept
      II, Muenchen Germany; Axel Ulsenheimer, Winfried
      Schraut, Inst fuer Immunologie, Muenchen Germany;
      Albrecht Schirren, Klinikum Grosshadern Med Dept II,
      Muenchen Germany; Martin Waechtler, Markus Backmund,
      Gen Hosp M´┐Żnchen Schwabing, Muenchen Germany; Helmut
      Diepolder, Gerd Pape, Klinikum Grosshadern Med Dept
      II, Muenchen Germany

      Below is the program book abstract, which I think
      portrays the essence of the oral presentation at the
      AASLD meeting. Another report on this presentation is
      being prepared. As you may know, German researchers
      first reported on treating acute HCV at DDW in the
      Spring 2001. A published article followed by much
      attention occurred in the Fall 2001. Identifying
      persons with acute HCV is very difficult just as it is
      in identifying acutely infected persons with HIV. But,
      if such a person can be identified treatment
      consideration may be crucial. Identification &
      treatment of acutely infected persons can be an
      important public policy position. This may have
      particular application to health care workers.

      Background: Although screening of blood products for
      hepatitis C virus (HCV) has virtually eliminated
      post-transfusion hepatitis C, HCV still causes about
      20% of cases of acute hepatitis today. These patients
      frequently present with acute symptomatic hepatitis C,
      which differs in many aspects from patients with
      post-transfusion hepatitis C. Little is known,
      however, about the natural course and the optimal
      treatment strategy for acute hepatitis C as it
      presents today.

      Methods: The diagnosis of a HCV in fifty-six
      consecutive patients was based on seroconversion to
      anti-HCV antibodies or clinical and biochemical
      criteria (acute onset of hepatitis with elevation of
      ALT at least 10x the upper limit of normal, exclusion
      of other liver diseases) and on the presence of
      HCV-RNA by RT-PCR in the first serum sample.

      Results: Fifty-six consecutive patients with acute
      hepatitis C were diagnosed in two large referral
      centers for infectious diseases and hepatology. 47/56
      patients presented with symptomatic disease (fatigue
      (24%), abdominal pain (14%), jaundice (24%), nausea
      (19%)) while 9/56 were clinically asymptomatic. The
      major risk factors for acute HCV infection were
      IV-drug abuse (n=14), recent medical procedures
      (n=17), HCV-positive sexual partner (n=5), and
      needle-stick injury in medical employees (n=5), in 15
      patients (27%) no risk factor or possible source of
      infection could be identified. Six patients received
      immediate antiviral therapy (IFN-a alone or in
      combination with ribavirin), 10 patients refused to
      therapy or were not eligable for IFN-a therapy. In 50
      patients, not being treated immediately, the natural
      course of acute HCV was further studied: 34/50 (68%)
      patients initially cleared the virus spontaneously
      within a median of 11,9 weeks (range 2 to 24 weeks),
      but only twenty-three (47%) persistently remained
      HCV-RNA negative until the end of follow-up (median
      23months, range 6 to 55 months) and were classified as
      self-limited hepatitis C. In eleven patients (22%) HCV
      RNA relapsed after a median of 23 weeks (range 8-86
      weeks) and 16/50 (32%) patients did not clear HCV
      infection spontaneously and developed chronic
      hepatitis C. Patients with self-limited hepatitis C
      (n=22) and those developing chronic hepatitis C (n=28)
      did not differ with regard to age, risk factors for
      HCV infection, HCV-genotype, or initial viral load.
      However, symptomatic disease, female sex, and a high
      peak bilirubin level were strong predictors of
      spontaneous HCV clearance. While 49% of patients with
      symptomatic acute HCV cleared infection spontaneously,
      none of the patients with asymptomatic acute HCV (n=9)
      cleared HCV infection without treatment.

      Since the majority (86%) of patients with spontaneous
      viral clearance lost HCV RNA within twelve weeks after
      onset of symptoms, antiviral therapy was recommended
      to patients who did not loose HCV RNA by week 12 after
      onset of symptoms. Of 34 patients with chronic
      hepatitis C, 24 patients started either
      interferon-alpha alone or in combination with
      ribavirin. So far, twenty-one patients responded with
      loss of HCV-RNA and normalization of
      aminotransferases; 15 of 16 IFN-responders who have
      completed follow-up (>6 months after end of treatment)
      are sustained responders and one patient relapsed.
      Five responders are still under follow-up
      (end-of-follow-up sustained response rate 82%) and
      three patients did not respond to antiviral therapy.
      Although not mentioned in the results but discussed in
      the oral presentation was the 6 patients who were
      treated immediately upon identification. And I recall
      4 or 5 of them had a virologic response.

      Conclusions: In the management of acute HCV infection
      a high spontaneous viral clearance rate within the
      first twelve weeks after onset of symptoms has to be
      considered. The strategy to treat symptomatic patients
      who remained HCV-RNA positive beyond three months
      after onset of disease led to an overall sustained
      viral clearance in 90% of patients, while unnecessary
      treatment was avoided in those with spontaneous viral
      clearance. In contrast patients with asymptomatic
      acute HCV infection are unlikely to clear the virus
      spontaneously and antiviral therapy should be
      commenced as early as possible.

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