title: The natural history of acute hepatitis C: clinical presentation, laboratory findings and treatment outcomes.
abstract: BACKGROUND
  Acute hepatitis C has variable modes of presentation and frequently results in chronic infection. Its optimal management has yet to be defined.
  
  
  OBJECTIVE
  To establish natural history and complications of treatment of acute hepatitis C.
  
  
  METHODS
  Data from all patients presenting with acute hepatitis C to the National Institutes of Health between 1994 and 2007 were reviewed.
  
  
  RESULTS
  Twenty-five patients were identified. Symptoms were reported by 80% and jaundice by 40%. Aminotransferase levels and hepatitis C virus (HCV) RNA levels fluctuated greatly; 18% of patients were intermittently negative for HCV RNA. Five patients recovered spontaneously whereas 20 developed chronicity or received interferon-based therapy during the acute phase. Among 15 patients treated during the acute phase with peginterferon with or without ribavirin for 24 weeks, all became HCV RNA negative within 4-8 weeks, and all except two (HIV-positive) achieved a sustained virological response. Side effects (particularly psychiatric) were common and limited treatment in 30%.
  
  
  CONCLUSIONS
  Among 25 patients with acute HCV infection, fluctuating illness was common and spontaneous recovery occurred in only 20%. Anti-viral treatment with a 24-week course of peginterferon and ribavirin was highly effective, but marked by frequent and severe side effects.
authors.affiliation: Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
authors.forename: R
authors.initials: R
authors.lastname: Loomba
authors.forename: M M
authors.initials: MM
authors.lastname: Rivera
authors.forename: R
authors.initials: R
authors.lastname: McBurney
authors.forename: Y
authors.initials: Y
authors.lastname: Park
authors.forename: V
authors.initials: V
authors.lastname: Haynes-Williams
authors.forename: B
authors.initials: B
authors.lastname: Rehermann
authors.forename: H J
authors.initials: HJ
authors.lastname: Alter
authors.forename: S K
authors.initials: SK
authors.lastname: Herrine
authors.forename: T J
authors.initials: TJ
authors.lastname: Liang
authors.forename: J H
authors.initials: JH
authors.lastname: Hoofnagle
authors.forename: T
authors.initials: T
authors.lastname: Heller
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000009:adverse effects*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D012254:Ribavirin / Q000009:adverse effects*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D012254:Ribavirin