Individuals presenting with acute HCV infection should be monitored using HCV RNA, transaminase (ALT, AST) levels, bilirubin level and INR every 2–6 weeks for the first 6 months or until parameters have stabilised and spontaneous clearance has either occurred or is deemed unlikely. Management is predominantly supportive, and admission to hospital is rarely required unless symptoms are uncontrolled or there is concern about rising bilirubin levels and/or INR. Acute liver failure is rare (< 1%) but may be indicated by a rising INR. Any person with an INR > 1.5 or signs of acute liver failure should be referred urgently to a liver transplant centre. Paracetamol and alcohol should be avoided during the period of acute HCV infection. Antiviral treatment during acute liver failure following HCV infection should only be considered by experienced clinicians and in conjunction with a liver transplant specialist.