Treatment of acute hepatitis C infection (HCV) in HIV-positive individuals

In a multicenter ACTG-study, 27 HIV-positive men with acute
hepatitis C were treated with Ledipasvir/Sofosbuvir for 8 weeks.
Acute hepatitis C was defined as detectable HCV-RNA in a
person with prior negative HCV-antibodies or negative HCVRNA
within the preceding 6 months or a new ALT elevation
and a detectable HCV-RNA according to the European AIDS
Treatment Network Acute Hepatitis C Infection Consensus
Panel. 5/17 patients had reinfections. All patients were on antiretroviral
therapy. Most patients were asymptomatic. 26/27
(23 1a and 3 1b) patients had genotype 1, 1/27 had genotype 4. 6
patients had HCV-RNA > 6 million IU/ml. All patients achieved
sustained viral response at week 12. The treatment was well tolerated
and no treatment interruptions occurred. No treatment
related serious adverse events were reported.

Ref; Naggie et al. Clin Infect Dis 2019;69:514-522

Comment: 8 weeks of ledipasvir/sofosbuvir cured all 27
HIV-positive patients with acute hepatitis C. 6 patients had
viral load > 6 million IU/μl. According to US guidelines only
patients with less than 6 million IU/ml should be treated for
8 weeks. No serious adverse effects or serious laboratory abnormalities
were reported. All patients had genotype 1 or 4. It
has been debated whether all acute hepatitis C infections must
be treated immediately as perhaps 15-20% may clear the infection
spontaneously and as treatment results are excellent also
in the chronic stage of infection. On the other hand immediate
treatment will prevent the further spread of HCV and the reasonable
conclusion is that all acute HCV-infections should be
treated, including in HIV-positive patients. 8 weeks of ledipasvir/
sofosbuvir seems like an effective and well tolerated option
in HIV-positive patients with genotype 1 or 4.