Acute hepatitis C infection in HIV-positive patients.

PURPOSE OF REVIEW: For 10 years now, we have been observing an epidemic of acute hepatitis C (AHC) infections among HIV-positive men who have sex with men. First outbreaks have been observed in Europe with recent epidemics also in the United States and Australia. Even though randomized controlled studies on the best management of AHC infections in HIV-positive individuals are still lacking, published data on clinical studies and cohort studies allow to give guidance on epidemiological trends, natural course and treatment of these patients.

RECENT FINDINGS: Observational data suggest that the early course of hepatitis C virus (HCV) RNA in the first 4 weeks after diagnosis may help to predict the natural course of AHC infections in HIV-infected patients. Starting antiviral therapy within 24 weeks after diagnosis yielded high response rates of 60-80%, regardless of HCV genotype. Pegylated interferon in combination with weight-adapted ribavirin is recommended for all HCV genotypes, though data on the added value of ribavirin are limited.

SUMMARY: Prevention efforts need to be refocused in order to help contain the current epidemic. Regular screening will help to diagnose AHC infections and allow timely monitoring of the natural course and access to early antiviral therapy if needed.