Clinical and Molecular Hepatology



Acute hepatitis C virus infection: clinical update and remaining challenges
Chen-Hua Liu1,2,3, Jia-Horng Kao1,2,4,5
1Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
2Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
3Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
4Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
5Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
Corresponding author: Jia-Horng Kao ,Tel: +886-2-23123456 ext 67307, Fax: +886-2-23825962, Email:
Received: October 30, 2022; Revised: January 27, 2023   Accepted: February 16, 2023.
Acute hepatitis C virus (HCV) infection is a global health concern with substantial geographical variation in the incidence rate. People who have received unsafe medical procedures, used injection drugs, and lived with human immunodeficiency virus are reported to be most susceptible to acute HCV infection. The diagnosis of acute HCV infection is particularly challenging in immunocompromised, reinfected, and superinfected patients due to difficulty in detecting anti-HCV antibody seroconversion and HCV ribonucleic acid (RNA) from a previously negative antibody response. With an excellent treatment effect on chronic HCV infection, recently, clinical trials investigating the benefit of direct-acting antivirals (DAAs) treatment for acute HCV infection have been conducted. Based on the results of cost-effectiveness analysis, DAAs should be initiated early in acute HCV infection prior to spontaneous viral clearance. Compared to the standard 8-12 week-course of DAAs for chronic HCV infection, DAAs treatment duration may be shortened to 6-8 weeks in acute HCV infection without compromising the efficacy. Standard DAA regimens provide comparable efficacy in treating HCV-reinfected patients and DAA-naïve ones. For cases contracting acute HCV infection from HCV-viremic liver transplant, a 12-week course of pangenotypic DAAs is suggested. While for cases contracting acute HCV infection from HCV-viremic non-liver solid organ transplants, a short course of prophylactic or pre-emptive DAAs is suggested. Currently, prophylactic HCV vaccines are unavailable. In addition to treatment scale-up for acute HCV infection, practice of universal precaution, harm reduction, safe sex, and vigilant surveillance after viral clearance remain critical in reducing HCV transmission.

Keywords :acute infection; hepatitis C virus; direct-acting antiviral

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