The development of genotype-wide direct-acting antivirals (DAAs) against hepatitis C virus (HCV) provides an essential tool for eliminating the virus.
These anti-HCV drugs have demonstrated safety and efficacy in both acute infection (infection for less than 6 months) and chronic infection (infection for more than 6 months).
Since there is no evidence of safety and efficacy of DAAs against HCV
Depending on the duration of infection, not treating patients infected for less than 6 months is advisable for strictly economic reasons.
Therefore, the sole purpose of this recommendation is to reduce the cost of treatment in some cases where the immune response can eliminate the virus and resolve the acute infection spontaneously.
High risk of hepatitis C transmission
Judging from the current epidemiological situation, most of the confirmed cases
Patients with acute HCV infection are those at very high risk of transmitting HCV
Infections in the environment: patients with sexually transmitted infections or those using HIV pre-exposure prophylaxis (PrEP) in the absence of multiple sexual contacts
Protect. Therefore, any delay in HCV treatment initiation implies a high risk of community transmission, which is an obstacle to achieving its elimination and promoting case maintenance in the aforementioned populations.
In this sense, guidelines developed by the European Association for the Study of the Liver (EASL) and the latest GEHEP-GESIDA guideline for HIV-infected patients with liver disease recommend that in the setting of sexually transmitted acute HCV infection, treatment should be started immediately, with the main goal of breaking the epidemic Disease transmission chain.
On the other hand, no studies assessed the costs/benefits of the following strategies:
Delay early treatment in this population. In addition, it should not be forgotten that HCV infection is a systemic infection and extrahepatic complications may arise at any time during its evolution.
For all these reasons, we believe that:
- Treatment against HCV should be advised and initiated immediately.
performed universally and immediately in all HCV-infected patients,
Regardless of evolution time. - Any recommendation to delay treatment of acute HCV infection implies certain individual and collective risks and has no proven economic benefit.
- Delay in treatment of patients with acute HCV infection is an obstacle to achieving the HCV elimination goals set by the World Health Organization.