Summary of Recommendations for Management of Acute HCV Infection
Recommended Testing for Diagnosing Acute HCV Infection
HCV antibody and HCV RNA testing are recommended when acute HCV infection is suspected due to exposure, clinical presentation, or elevated aminotransferase levels (see Figure). Rating: Class I, Level C
Recommendations for Medical Management and Monitoring in Acute HCV Infection
Regular laboratory monitoring is recommended in the setting of acute HCV infection. Monitoring HCV RNA (eg, every 4 weeks to 8 weeks) for 6 months to 12 months is also recommended to determine spontaneous clearance of HCV infection versus persistence of infection. Rating: Class I, Level B
Counseling is recommended for patients with acute HCV infection to avoid hepatotoxic insults, including hepatotoxic drugs (eg, acetaminophen) and alcohol consumption, and to reduce the risk of HCV transmission to others. Rating: Class I, Level C
Referral to an addiction medicine specialist is recommended for patients with acute HCV infection related to substance use. Rating: Class I, Level B
Recommended Treatment for Patients with Acute HCV Infection
If the practitioner and patient have decided that a delay in treatment initiation is acceptable, monitoring for spontaneous clearance is recommended for a minimum of 6 months. When the decision is made to initiate treatment after 6 months, treating as described for chronic hepatitis C is recommended. (see Initial Treatment of HCV Infection) Rating: Class IIa, Level C
If a decision has been made to initiate treatment during the acute infection period, monitoring HCV RNA for at least 12 weeks to 16 weeks before starting treatment is recommended to allow for spontaneous clearance. Rating: Class IIa, Level C
Recommended Regimens for Patients with Acute HCV Infection.
Owing to high efficacy and safety, the same regimens that are recommended for chronic HCV infection are recommended for acute infection. Rating: Class IIa, Level C
The following are Not Recommended in the Management of Acute HCV Infection.
Preexposure or postexposure prophylaxis with antiviral therapy is Not Recommended. Rating: Class III, Level C
For patients in whom HCV infection spontaneously clears, treatment is Not Recommended. Rating: Class III, Level B