UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2015 UpToDate®

Clinical manifestations, diagnosis, and treatment of acute hepatitis C in adults

Authors
Reinhard Lorenz, MD
Stefan Endres, MD
Section Editor
Adrian M Di Bisceglie, MD
Deputy Editor
Allyson Bloom, MD

INTRODUCTION

By convention, acute hepatitis C virus (HCV) infection refers to the first six months of HCV infection following presumed HCV exposure [1]. While HCV infection is estimated to account for 15 percent of symptomatic cases of acute liver disease in the United States, the majority of patients with acute HCV go undetected [2,3]. This is due in large part to the fact that patients with acute HCV are typically asymptomatic. In the United States, the Centers for Disease Control and Prevention estimated that there were 16,500 new cases of HCV in 2011, of which only 1,229 cases were reported [4].

This topic will review acute HCV in adults. Issues related to the transmission of HCV, screening for HCV, and managing patients with chronic HCV are discussed elsewhere. (See "Epidemiology and transmission of hepatitis C virus infection" and "Clinical manifestations and natural history of chronic hepatitis C virus infection" and "Screening for chronic hepatitis C virus infection" and "Overview of the management of chronic hepatitis C virus infection" and "Diagnosis and evaluation of chronic hepatitis C virus infection".)

GUIDELINES

Guidelines for the diagnosis and management of hepatitis C virus (HCV) infection were released jointly by the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) in 2014, are continuously updated, and can be accessed at www.hcvguidelines.org [5]. Recommendations on the management of acute HCV infection were added to these guidelines in 2015. The discussion in this topic is generally consistent with those guidelines.

Other guidelines include treatment recommendations from the European Association for the Study of the Liver (EASL), which was published in 2014 [6], and United Kingdom consensus guidelines, which were updated in 2014 [7].

CLINICAL MANIFESTATIONS

Most patients who are acutely infected with hepatitis C virus (HCV) are asymptomatic. Symptomatic patients may experience jaundice, nausea, dark urine, and right upper quadrant pain. Patients with acute HCV infection typically have moderate to high serum aminotransferase elevations (see 'Laboratory findings' below). These may go undetected in asymptomatic patients.

                            

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jul 2015. | This topic last updated: Jun 15, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2015 UpToDate, Inc.
References
Top
  1. Blackard JT, Shata MT, Shire NJ, Sherman KE. Acute hepatitis C virus infection: a chronic problem. Hepatology 2008; 47:321.
  2. Williams I. Epidemiology of hepatitis C in the United States. Am J Med 1999; 107:2S.
  3. Armstrong GL, Alter MJ, McQuillan GM, Margolis HS. The past incidence of hepatitis C virus infection: implications for the future burden of chronic liver disease in the United States. Hepatology 2000; 31:777.
  4. http://www.cdc.gov/hepatitis/hcv/StatisticsHCV.htm (Accessed on September 19, 2012).
  5. Recommendations for Testing, Managing, and Treating Hepatitis C. Joint panel from the American Association of the Study of Liver Diseases and the Infectious Diseases Society of America. January 2014 http://www.hcvguidelines.org/ (Accessed on January 01, 2015).
  6. European Association for the Study of the Liver. Recommendations on treatment of hepatitis C. 2014 http://files.easl.eu/easl-recommendations-on-treatment-of-hepatitis-C.pdf (Accessed on April 14, 2014).
  7. Miller MH, Agarwal K, Austin A, et al. Review article: 2014 UK consensus guidelines - hepatitis C management and direct-acting anti-viral therapy. Aliment Pharmacol Ther 2014; 39:1363.
  8. Marcellin P. Hepatitis C: the clinical spectrum of the disease. J Hepatol 1999; 31 Suppl 1:9.
  9. Seeff LB. Natural history of hepatitis C. Hepatology 1997; 26:21S.
  10. Gerlach JT, Diepolder HM, Zachoval R, et al. Acute hepatitis C: high rate of both spontaneous and treatment-induced viral clearance. Gastroenterology 2003; 125:80.
  11. Loomba R, Rivera MM, McBurney R, et al. The natural history of acute hepatitis C: clinical presentation, laboratory findings and treatment outcomes. Aliment Pharmacol Ther 2011; 33:559.
  12. Hoofnagle JH, Carithers RL Jr, Shapiro C, Ascher N. Fulminant hepatic failure: summary of a workshop. Hepatology 1995; 21:240.
  13. Chu CM, Yeh CT, Liaw YF. Fulminant hepatic failure in acute hepatitis C: increased risk in chronic carriers of hepatitis B virus. Gut 1999; 45:613.
  14. Jaeckel E, Cornberg M, Wedemeyer H, et al. Treatment of acute hepatitis C with interferon alfa-2b. N Engl J Med 2001; 345:1452.
  15. Maheshwari A, Ray S, Thuluvath PJ. Acute hepatitis C. Lancet 2008; 372:321.
  16. Deterding K, Wiegand J, Grüner N, et al. The German Hep-Net acute hepatitis C cohort: impact of viral and host factors on the initial presentation of acute hepatitis C virus infection. Z Gastroenterol 2009; 47:531.
  17. Maheshwari A, Thuluvath PJ. Management of acute hepatitis C. Clin Liver Dis 2010; 14:169.
  18. McGovern BH, Birch CE, Bowen MJ, et al. Improving the diagnosis of acute hepatitis C virus infection with expanded viral load criteria. Clin Infect Dis 2009; 49:1051.
  19. Santantonio T, Sinisi E, Guastadisegni A, et al. Natural course of acute hepatitis C: a long-term prospective study. Dig Liver Dis 2003; 35:104.
  20. Corey KE, Ross AS, Wurcel A, et al. Outcomes and treatment of acute hepatitis C virus infection in a United States population. Clin Gastroenterol Hepatol 2006; 4:1278.
  21. Vega Palomares R, Planas Vilà R, Durández Lazaro R, Fábregas Puigtió S. [Acute hepatitis C: response to treatment with interferon-alpha plus ribavirin]. Gastroenterol Hepatol 2002; 25:483.
  22. Fanning L, Kenny-Walsh E, Levis J, et al. Natural fluctuations of hepatitis C viral load in a homogeneous patient population: a prospective study. Hepatology 2000; 31:225.
  23. Barreiro P, Labarga P, Fernández-Montero JV, et al. Longitudinal changes in viral RNA concentration in patients with chronic hepatitis C and/or HIV infection in the absence of antiviral therapy. J Clin Virol 2013; 58:391.
  24. National Institutes of Health. National Institutes of Health Consensus Development Conference Statement: Management of hepatitis C: 2002--June 10-12, 2002. Hepatology 2002; 36:S3.
  25. Hoofnagle JH. Hepatitis C: the clinical spectrum of disease. Hepatology 1997; 26:15S.
  26. Farci P, Alter HJ, Wong D, et al. A long-term study of hepatitis C virus replication in non-A, non-B hepatitis. N Engl J Med 1991; 325:98.
  27. Wang TY, Kuo HT, Chen LC, et al. Use of polymerase chain reaction for early detection and management of hepatitis C virus infection after needlestick injury. Ann Clin Lab Sci 2002; 32:137.
  28. Haydon GH, Jarvis LM, Blair CS, et al. Clinical significance of intrahepatic hepatitis C virus levels in patients with chronic HCV infection. Gut 1998; 42:570.
  29. Beld M, Penning M, van Putten M, et al. Low levels of hepatitis C virus RNA in serum, plasma, and peripheral blood mononuclear cells of injecting drug users during long antibody-undetectable periods before seroconversion. Blood 1999; 94:1183.
  30. Wiese M, Grüngreiff K, Güthoff W, et al. Outcome in a hepatitis C (genotype 1b) single source outbreak in Germany--a 25-year multicenter study. J Hepatol 2005; 43:590.
  31. Nikolaeva LI, Blokhina NP, Tsurikova NN, et al. Virus-specific antibody titres in different phases of hepatitis C virus infection. J Viral Hepat 2002; 9:429.
  32. Wawrzynowicz-Syczewska M, Kubicka J, Lewandowski Z, et al. Natural history of acute symptomatic hepatitis type C. Infection 2004; 32:138.
  33. Barrera JM, Bruguera M, Ercilla MG, et al. Persistent hepatitis C viremia after acute self-limiting posttransfusion hepatitis C. Hepatology 1995; 21:639.
  34. Hofer H, Watkins-Riedel T, Janata O, et al. Spontaneous viral clearance in patients with acute hepatitis C can be predicted by repeated measurements of serum viral load. Hepatology 2003; 37:60.
  35. Wiese M, Berr F, Lafrenz M, et al. Low frequency of cirrhosis in a hepatitis C (genotype 1b) single-source outbreak in germany: a 20-year multicenter study. Hepatology 2000; 32:91.
  36. Rodger AJ, Roberts S, Lanigan A, et al. Assessment of long-term outcomes of community-acquired hepatitis C infection in a cohort with sera stored from 1971 to 1975. Hepatology 2000; 32:582.
  37. Thomas DL, Astemborski J, Rai RM, et al. The natural history of hepatitis C virus infection: host, viral, and environmental factors. JAMA 2000; 284:450.
  38. Villano SA, Vlahov D, Nelson KE, et al. Persistence of viremia and the importance of long-term follow-up after acute hepatitis C infection. Hepatology 1999; 29:908.
  39. Seeff LB, Hollinger FB, Alter HJ, et al. Long-term mortality and morbidity of transfusion-associated non-A, non-B, and type C hepatitis: A National Heart, Lung, and Blood Institute collaborative study. Hepatology 2001; 33:455.
  40. Alter HJ, Conry-Cantilena C, Melpolder J, et al. Hepatitis C in asymptomatic blood donors. Hepatology 1997; 26:29S.
  41. Kenny-Walsh E. Clinical outcomes after hepatitis C infection from contaminated anti-D immune globulin. Irish Hepatology Research Group. N Engl J Med 1999; 340:1228.
  42. Vogt M, Lang T, Frösner G, et al. Prevalence and clinical outcome of hepatitis C infection in children who underwent cardiac surgery before the implementation of blood-donor screening. N Engl J Med 1999; 341:866.
  43. Grebely J, Page K, Sacks-Davis R, et al. The effects of female sex, viral genotype, and IL28B genotype on spontaneous clearance of acute hepatitis C virus infection. Hepatology 2014; 59:109.
  44. Kamal SM, Kassim SK, Ahmed AI, et al. Host and viral determinants of the outcome of exposure to HCV infection genotype 4: a large longitudinal study. Am J Gastroenterol 2014; 109:199.
  45. Nunnari G, Montineri A, Portelli V, et al. The use of peginterferon in monotherapy or in combination with ribavirin for the treatment of acute hepatitis C. Eur Rev Med Pharmacol Sci 2012; 16:1013.
  46. Pérez-Álvarez R, García-Samaniego J, Solá R, et al. Acute hepatitis C in Spain: a retrospective study of 131 cases. Rev Esp Enferm Dig 2012; 104:21.
  47. Morin T, Pariente A, Lahmek P, Investigator Group of ANGH, SPILF, FNPRH. Favorable outcome of acute occupational hepatitis C in healthcare workers: a multicenter French study on 23 cases. Eur J Gastroenterol Hepatol 2011; 23:515.
  48. Grebely J, Pham ST, Matthews GV, et al. Hepatitis C virus reinfection and superinfection among treated and untreated participants with recent infection. Hepatology 2012; 55:1058.
  49. Ferreira Ade S, Perez Rde M, Ferraz ML, et al. Acute hepatitis C in Brazil: results of a national survey. J Med Virol 2011; 83:1738.
  50. McDonald SA, Hutchinson SJ, Cameron SO, et al. Examination of the risk of reinfection with hepatitis C among injecting drug users who have been tested in Glasgow. Int J Drug Policy 2012; 23:353.
  51. Missale G, Bertoni R, Lamonaca V, et al. Different clinical behaviors of acute hepatitis C virus infection are associated with different vigor of the anti-viral cell-mediated immune response. J Clin Invest 1996; 98:706.
  52. Diepolder HM, Zachoval R, Hoffmann RM, et al. Possible mechanism involving T-lymphocyte response to non-structural protein 3 in viral clearance in acute hepatitis C virus infection. Lancet 1995; 346:1006.
  53. Sacks-Davis R, Grebely J, Dore GJ, et al. Hepatitis C Virus Reinfection and Spontaneous Clearance of Reinfection-the InC3 Study. J Infect Dis 2015.
  54. van den Berg CH, Grady BP, Schinkel J, et al. Female sex and IL28B, a synergism for spontaneous viral clearance in hepatitis C virus (HCV) seroconverters from a community-based cohort. PLoS One 2011; 6:e27555.
  55. Grebely J, Petoumenos K, Hellard M, et al. Potential role for interleukin-28B genotype in treatment decision-making in recent hepatitis C virus infection. Hepatology 2010; 52:1216.
  56. Cerny A, Chisari FV. Pathogenesis of chronic hepatitis C: immunological features of hepatic injury and viral persistence. Hepatology 1999; 30:595.
  57. Heller T, Werner JM, Rahman F, et al. Occupational exposure to hepatitis C virus: early T-cell responses in the absence of seroconversion in a longitudinal cohort study. J Infect Dis 2013; 208:1020.
  58. Kamal SM, Fouly AE, Kamel RR, et al. Peginterferon alfa-2b therapy in acute hepatitis C: impact of onset of therapy on sustained virologic response. Gastroenterology 2006; 130:632.
  59. Corey KE, Mendez-Navarro J, Gorospe EC, et al. Early treatment improves outcomes in acute hepatitis C virus infection: a meta-analysis. J Viral Hepat 2010; 17:201.
  60. Licata A, Di Bona D, Schepis F, et al. When and how to treat acute hepatitis C? J Hepatol 2003; 39:1056.
  61. Deterding K, Grüner N, Buggisch P, et al. Delayed versus immediate treatment for patients with acute hepatitis C: a randomised controlled non-inferiority trial. Lancet Infect Dis 2013; 13:497.
  62. Vogel W, Graziadei I, Umlauft F, et al. High-dose interferon-alpha2b treatment prevents chronicity in acute hepatitis C: a pilot study. Dig Dis Sci 1996; 41:81S.
  63. Lampertico P, Rumi M, Romeo R, et al. A multicenter randomized controlled trial of recombinant interferon-alpha 2b in patients with acute transfusion-associated hepatitis C. Hepatology 1994; 19:19.
  64. Gürsoy M, Gür G, Arslan H, et al. Interferon therapy in haemodialysis patients with acute hepatitis C virus infection and factors that predict response to treatment. J Viral Hepat 2001; 8:70.
  65. Delwaide J, Bourgeois N, Gérard C, et al. Treatment of acute hepatitis C with interferon alpha-2b: early initiation of treatment is the most effective predictive factor of sustained viral response. Aliment Pharmacol Ther 2004; 20:15.
  66. Rocca P, Bailly F, Chevallier M, et al. [Early treatment of acute hepatitis C with interferon alpha-2b or interferon alpha-2b plus ribavirin: study of sixteen patients]. Gastroenterol Clin Biol 2003; 27:294.
  67. Nomura H, Sou S, Tanimoto H, et al. Short-term interferon-alfa therapy for acute hepatitis C: a randomized controlled trial. Hepatology 2004; 39:1213.
  68. Calleri G, Colombatto P, Gozzelino M, et al. Natural beta interferon in acute type-C hepatitis patients: a randomized controlled trial. Ital J Gastroenterol Hepatol 1998; 30:181.
  69. Takano S, Satomura Y, Omata M. Effects of interferon beta on non-A, non-B acute hepatitis: a prospective, randomized, controlled-dose study. Japan Acute Hepatitis Cooperative Study Group. Gastroenterology 1994; 107:805.
  70. Hwang SJ, Lee SD, Chan CY, et al. A randomized controlled trial of recombinant interferon alpha-2b in the treatment of Chinese patients with acute post-transfusion hepatitis C. J Hepatol 1994; 21:831.
  71. Santantonio T, Fasano M, Sagnelli E, et al. Acute hepatitis C: a 24-week course of pegylated interferon α-2b versus a 12-week course of pegylated interferon α-2b alone or with ribavirin. Hepatology 2014; 59:2101.
  72. Wiegand J, Buggisch P, Boecher W, et al. Early monotherapy with pegylated interferon alpha-2b for acute hepatitis C infection: the HEP-NET acute-HCV-II study. Hepatology 2006; 43:250.
  73. Santantonio T, Fasano M, Sinisi E, et al. Efficacy of a 24-week course of PEG-interferon alpha-2b monotherapy in patients with acute hepatitis C after failure of spontaneous clearance. J Hepatol 2005; 42:329.
  74. Kamal SM, Ismail A, Graham CS, et al. Pegylated interferon alpha therapy in acute hepatitis C: relation to hepatitis C virus-specific T cell response kinetics. Hepatology 2004; 39:1721.
  75. Kamal SM, Moustafa KN, Chen J, et al. Duration of peginterferon therapy in acute hepatitis C: a randomized trial. Hepatology 2006; 43:923.
  76. De Rosa FG, Bargiacchi O, Audagnotto S, et al. Twelve-week treatment of acute hepatitis C virus with pegylated interferon- alpha -2b in injection drug users. Clin Infect Dis 2007; 45:583.
  77. Broers B, Helbling B, François A, et al. Barriers to interferon-alpha therapy are higher in intravenous drug users than in other patients with acute hepatitis C. J Hepatol 2005; 42:323.
  78. Serpaggi J, Chaix ML, Batisse D, et al. Sexually transmitted acute infection with a clustered genotype 4 hepatitis C virus in HIV-1-infected men and inefficacy of early antiviral therapy. AIDS 2006; 20:233.
  79. Danta M, Dusheiko GM. Acute HCV in HIV-positive individuals - a review. Curr Pharm Des 2008; 14:1690.
  80. Laguno M, Martínez-Rebollar M, Perez I, et al. Low rate of sustained virological response in an outbreak of acute hepatitis C in HIV-infected patients. AIDS Res Hum Retroviruses 2012; 28:1294.
  81. Matthews GV, Hellard M, Haber P, et al. Characteristics and treatment outcomes among HIV-infected individuals in the Australian Trial in Acute Hepatitis C. Clin Infect Dis 2009; 48:650.
  82. Dominguez S, Ghosn J, Valantin MA, et al. Efficacy of early treatment of acute hepatitis C infection with pegylated interferon and ribavirin in HIV-infected patients. AIDS 2006; 20:1157.
  83. Piroth L, Larsen C, Binquet C, et al. Treatment of acute hepatitis C in human immunodeficiency virus-infected patients: the HEPAIG study. Hepatology 2010; 52:1915.
  84. Fierer DS, Dieterich DT, Mullen MP, et al. Telaprevir in the treatment of acute hepatitis C virus infection in HIV-infected men. Clin Infect Dis 2014; 58:873.
  85. Götz HM, van Doornum G, Niesters HG, et al. A cluster of acute hepatitis C virus infection among men who have sex with men--results from contact tracing and public health implications. AIDS 2005; 19:969.
  86. Fabrizi F, Dixit V, Messa P, Martin P. Interferon therapy of acute hepatitis C in dialysis patients: meta-analysis. J Viral Hepat 2012; 19:784.