M
anagement of acute infection with the hepatitis C virus (HCV) is still a matter of debate and different treatment algorithms have been proposed in recent years. The 2002 NIH consensus conference was rather cautious in recommending therapy for patients with acute hepatitis C, 1 while the recently updated French, Swedish, and German consensus guidelines suggested early treatment with interferon alfa. [2][3][4] The need for additional trials, however, has been highlighted throughout the debate. Thus, where are we now, almost two years after the NIH conference?
Undoubtedly, the evolution to chronicity of an acute infection with HCV should be avoided, considering the potential risk for the development of liver cirrhosis and hepatocellular carcinoma in patients with chronic hepatitis C. 5 In addition, HCV infection can be associated with extrahepatic manifestations, as well as result in significant social and legal consequences, especially for medical health professionals. Fortunately, acute hepatitis C has become a quite uncommon disease, although new infections still occur. As the majority of acute HCV cases nowadays affect IV drug addicts, treatment trials have become difficult to perform, with most studies on acute hepatitis C being of limited size or rigor. Well-performed trials are, however, urgently needed, since there is still no prophylactic vaccine available for HCV. Thus, whom do we really have to treat? If we treat, when to start? Is interferon monotherapy sufficient, or do we need combination with ribavirin? How long to treat? Are there differences among HCV genotypes, patients with high or low viral load, the sexes, or different ethnic backgrounds?
A major problem for the design of treatment trials in acute hepatitis C is the variable course of the infection Abbreviations: HCV, hepatitis C virus; aHCV-ab, anti-hepatitis C virus-antibodies .