Distinct features in natural history and outcomes of acute hepatitis C.
BACKGROUND
Acute hepatitis C (AHCV) provides a diagnostic challenge with diverse clinical presentations.


OBJECTIVE
This study was aimed to examine the clinical and demographic features as well as outcomes in AHCV patients identified from inpatient and outpatient hospital settings.


METHODS
Patients with suspected AHCV were recruited from Philadelphia VA Medical Center, Hospital of University of Pennsylvania and Brooklyn VA Medical Center between 2000 and 2010. AHCV was diagnosed by acute serum alanine aminotransferase elevation with anti-hepatitis C virus (HCV) seroconversion, HCV-RNA fluctuations above 1 log, and/or recent high-risk exposure without prior HCV infection, excluding those with human immunodeficiency virus infection. Clinical and therapeutic outcomes were monitored for at least 6 months.


RESULTS
A total of 40 AHCV patients were enrolled with a median follow-up of 129 weeks. They were mostly men (68%) and whites (73%) with median age of 43 years, diverse risk factors (33% injection drugs, 20% health care-associated, 3% sexual, and 45% unknown), and wide variations in peak alanine aminotransferase (143 to 3435 U/L) and total bilirubin levels (0.4 to 19.3 mg/dL). Viremia resolved spontaneously in 23% and persisted without therapy in 27%, whereas 50% received interferon α-based therapy with 90% cure (18/20). Distinct clinical scenarios included: (1) wide viremic fluctuations >1 log (65%) and intermittent HCV-RNA negativity; (2) autoantibodies (25% antinuclear antibodies, 69% antismooth muscle antibodies) or autoimmune features; (3) delayed spontaneous viral clearance in 2 patients; (4) rapid cirrhosis progression in 2 patients.


CONCLUSIONS
AHCV is a heterogenous disease that requires careful monitoring. The lack of apparent risk factor in high proportion of patients and its diverse presentations warrant diagnostic vigilance.
*Department of Medicine, University of Pennsylvania ‡Department of Medicine, Division of Gastroenterology and Hepatology, Philadelphia VA Medical Center §Pennsylvania Hospital, Philadelphia, PA †Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand ∥VA New York Harbor Healthcare System, Brooklyn, NY.
Chalermrat
C
Bunchorntavakul
Lisa M
LM
Jones
Masahiro
M
Kikuchi
Mary E
ME
Valiga
David E
DE
Kaplan
Frederick A
FA
Nunes
Ayse
A
Aytaman
K Rajender
KR
Reddy
Kyong-Mi
KM
Chang
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D001663:Bilirubin / Q000097:blood; D005260:Female; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000032:analysis; D012307:Risk Factors; D016896:Treatment Outcome; D014766:Viremia / Q000188:drug therapy
D000998:Antiviral Agents; D018937:Hepatitis C Antibodies; D016898:Interferon-alpha; D012367:RNA, Viral; D000410:Alanine Transaminase; D001663:Bilirubin