Acute viral hepatitis C should be treated.

68 Indian Journal of Gastroenterology 2005 Vol 24 March April A infection due to HCV results in a chronic course in 55% to 85% of cases.1 Chronic hepatitis C virus (HCV) infection is one of the leading causes of chronic liver disease, affecting about 170 million people worldwide.2 It is also a major cause of liver failure and hepatocellular carcinoma and is the leading indication for liver transplantation. The most important risk factors for HCV infection are intravenous drug abuse, needle stick injury, nosocomial, and sexual transmission. Chronic HCV carriers are a potential source for transmission of this infection. Therefore, the evolution to chronicity of acute HCV infection must be avoided. Although chronic HCV infection of genotypes 2 and 3 can be cured in 85% of patients with pegylated interferon-a and ribavirin, sustained viral response (SVR) in genotypes 1 and 4 is between 40% and 50%.3,4 While patients with chronic hepatitis C require a combination treatment with interferon and ribavirin for 6 months (genotype 2 or 3) to 12 months (genotype 1 or 4) or even longer in the absence of rapid virological response,5 treatment for acute hepatitis C (AHC) is for a shorter duration. The majority of patients with AHC are asymptomatic. However, mild jaundice may be seen in 60% to 85% of these patients.6,7 The asymptomatic patients are often detected by surveillance such as following individuals with needle-stick exposure, intravenous drug abusers, patients on long-term hemodialysis, etc. There is no specific diagnostic test for AHC; the diagnosis is usually based on seroconversion to anti-HCV antibodies and on the presence of HCV RNA in the first serum sample. The best method for detecting acute HCV infection is to screen high-risk patients for seroconversion from a past negative to a positive anti-HCV test. Several questions need to be answered before treatment for patients with AHC can be recommended. These are: (i) Is interferon effective in patients with AHC? (ii) When should therapy be started? (iii) What is the optimal duration of treatment?