Inserm ATIP-AVENIR "Modélisation, aide à la décision et coût-efficacité en maladies infectieuses", Lille/Paris, France; EA2694, Université Lille Nord de France, Lille, France.
BACKGROUND AND AIMS:
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 3 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); (3) at 4/5 months (delayed initiation).
We calculated spontaneous HCV clearance probability based on 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).
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 v in non-C/C patients with aAHC) regardless of the presence of symptoms or IL28B genotype.
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 poor HCV treatment efficacy's differential between months 3 and 4/5.