When and how to treat acute hepatitis C?
BACKGROUND
Appropriate treatment of acute hepatitis C is still a matter of controversy due to the lack of large controlled trials.


OBJECTIVE
To assess the effectiveness of interferon as treatment for acute hepatitis C by meta-analysis.


METHODS
MEDLINE search (1985-2002) was supplemented with manual searches of reference lists. Studies were included if they were controlled trials comparing interferon to no treatment and if they included patients with either post-transfusion or sporadic acute hepatitis C. Twelve trials were analyzed (414 patients). The outcome assessed was the sustained virological response (SVR) rate (undetectable hepatitis C virus RNA in serum at least 6 months after cessation of therapy).


RESULTS
Interferon significantly increased the SVR (risk difference 49%; 95% confidence interval 32.9-65%) in comparison to no treatment. The risk difference of SVR increased from 5 to 90% when trials were ordered by increasing interferon weekly dose. Delaying therapy by 8-12 weeks after the onset of disease does not compromise the SVR rate.


CONCLUSIONS
Current evidence is sufficient to recommend interferon treatment of patients with acute hepatitis C. A later initiation of therapy yields the same likelihood of response as early treatment. A daily induction dose during the 1st month is the best option of treatment.
Licata
Anna
A
Cattedra di Gastroenterologia, Istituto di Clinica Medica I, University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy.
Di Bona
Danilo
D
Schepis
Filippo
F
Shahied
Lillian
L
Craxí
Antonio
A
Cammà
Calogero
C
D000208:Acute Disease; D000998:Antiviral Agents / Q000627:therapeutic use*; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000627:therapeutic use*
D000998:Antiviral Agents; D007372:Interferons