Treatment of acute HCV infection

The optimal timing and regimen for acute hepatitis C treatment is unclear due to a lack of data with IFN-free DAA therapies. Among those who do not have ongoing risk factors for hepatitis C transmission, it is reasonable to observe people for spontaneous clearance. If spontaneous clearance has not occurred by 6 months after the transmission event, the person can be considered to have chronic HCV infection and treated according to current DAA treatment guidelines.

Treatment can be considered earlier in specific situations, including in occupationally infected health care workers. Treatment is also actively recommended for people with risk factors for hepatitis C transmission, to prevent forward transmission events. Higher-risk populations for transmission include PWID and HIV-positive MSM. If treatment with DAA-based therapy is considered in the first 6 months after HCV infection, a standard duration of 8–12 weeks should be applied. Treatment in this phase has been shown to be safe and highly effective, with good adherence, even in high-risk populations.[120,122]

There is no place for the use of post-exposure prophylaxis with antiviral therapy after HCV exposure. Following acute HCV infection, all individuals should undergo risk behaviour education and discussion regarding the possibility of reinfection risk after spontaneous or treatment-induced clearance.