title: Immediate vs. delayed treatment in patients with acute hepatitis C based on IL28B polymorphism: a model-based analysis.
abstract: OBJECTIVE
  Timing of treatment initiation in acute hepatitis C (AHC) patients is unclear. Spontaneous viral clearance argues for a "watch-and-wait" strategy. However, early initiation of treatment could increase the sustained virological response (SVR) rate. We compared three different HCV treatment initiation strategies in patients with AHC according to presence of clinical symptoms and IL28B polymorphism: (1) within 2 months after transmission (immediate initiation), (2) at 3 months (early initiation), and (3) at 4/5 months (delayed initiation).
  
  
  METHODS
  We calculated spontaneous HCV clearance probability based on the symptomatic (sAHC) and asymptomatic (aAHC) nature of disease and C/C or non-C/C genotype. We used different SVR probabilities according to delay between transmission and treatment. We estimated the probability of developing chronic hepatitis C (CHC).
  
  
  RESULTS
  The probability of developing CHC was lower for immediate treatment initiation (7.1% in C/C and 7.3% in non-C/C patients with sAHC; 6.6% in C/C and 7.1% in non-C/C patients with aAHC) than for delayed initiation (13.5% in C/C and 18.0% in non-C/C patients with sAHC; 14.6% in C/C and 18.5% in non-C/C patients with aAHC) regardless of the presence of symptoms or IL28B genotype.
  
  
  CONCLUSIONS
  In patients such as health care workers, in whom HCV is detected ≤ 2 months following transmission, treatment should be immediately initiated regardless of clinical symptoms and IL28B polymorphism. In those in whom HCV is detected>2 months after transmission, treatment 4/5 months after may be preferable because of a higher rate of spontaneous HCV clearance after 2 months and a poor HCV treatment efficacy's differential between months 3 and 4/5.
authors.affiliation: Inserm ATIP-AVENIR Modélisation, aide à la décision et coût-efficacité en maladies infectieuses, Lille/Paris, France. sylvie.burban@neuf.fr
authors.forename: Sylvie
authors.initials: S
authors.lastname: Deuffic-Burban
authors.forename: Hélène
authors.initials: H
authors.lastname: Castel
authors.forename: Johannes
authors.initials: J
authors.lastname: Wiegand
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
authors.forename: Heiner
authors.initials: H
authors.lastname: Wedemeyer
authors.forename: Philippe
authors.initials: P
authors.lastname: Mathurin
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
mesh_terms: D000208:Acute Disease; D000998:Antiviral Agents / Q000627:therapeutic use*; D005838:Genotype; D006526:Hepatitis C / Q000188:drug therapy* / Q000235:genetics / Q000821:virology; D006801:Humans; D007372:Interferons; D007378:Interleukins / Q000235:genetics*; D011110:Polymorphism, Genetic; D012367:RNA, Viral / Q000032:analysis; D000095022:Interferon Lambda
chemical_list: D000998:Antiviral Agents; D007372:Interferons; D007378:Interleukins; D012367:RNA, Viral; C000624353:interferon-lambda, human; D000095022:Interferon Lambda