WESTPORT, CT (Reuters Health) – Early treatment of acute hepatitis C with a relatively short, high-dose regimen of interferon alpha-2b prevents the development of chronic infection in most patients, German investigators report in The New England Journal of Medicine for November 15.
Forty-four patients with acute hepatitis C were treated with 5 million U of interferon alpha-2b SC daily for 4 weeks, followed by 5 million U three times a week for an additional 20 weeks. Time from infection to the first signs or symptoms of illness ranged from 15 to 105 days (mean 54 days), while the time from infection until start of therapy was 30 to 112 days (mean 89 days).
Dr. Michael P. Manns, of the Medizinische Hochschule Hannover, and members of the German Acute Hepatitis C Therapy Group documented that the average time required for HCV RNA to become undetectable after treatment initiation was 3.2 weeks. All patients reached this goal during therapy.
All but nine patients had normal alanine aminotransferase levels by the end of therapy. Those nine exhibited a mild elevation of not more than twice the upper limit of the normal range. Although thrombocytopenia and leukopenia developed in all patients, these abnormalities resolved after therapy ended.
Dr. Jay H. Hoofnagle, of the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Maryland, notes in an editorial that the recovery rate observed by Dr. Manns' team well exceeds the natural spontaneous recovery rate of 15% to 30%. The rate is also higher than the best rate observed for patients with chronic hepatitis C.
Still, Dr. Hoofnagle questions the value of initiating therapy immediately in patients with acute infection, given the low rate of morbidity and mortality during the first 2 decades of chronic liver disease. He suggests that another strategy, delaying therapy to see if the infection resolves spontaneously, may be feasible.
N Engl J Med 2001;345:1452-1457,1495-1497.
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