Efficacy of a 24-week course of PEG-interferon alpha-2b monotherapy in patients with acute hepatitis C after failure of spontaneous clearance.
Interferon (IFN) monotherapy significantly reduces the chronicity rate of acute hepatitis C (AHC) but optimal regimen and treatment timing remain undefined. The aim of this study was to assess the efficacy of a 6-month course of pegylated IFN (PEG-IFN) alpha-2b monotherapy in AHC patients and to investigate if IFN treatment initiated after 12 weeks from clinical presentation, still achieved a high response rate. Sixteen AHC patients still viremic after 12 weeks from the onset were treated with PEG-IFN alpha-2b (1.5 mcg/kg once weekly) for 6 months and followed for at least 12 months. Response to therapy was defined as normal ALT values and undetectable HCV RNA (<50 IU/ml) at the end of therapy, after 6 (sustained response) and 12 months follow-up (long-term response). At the end of treatment, HCV RNA was undetectable in 15/16 patients while ALT normalized in 14/16 patients. After 6 and 12 months follow-up, 15/16 patients (94%) showed virological and biochemical response. A 6-month course of PEG-IFN alpha-2b is effective in inducing resolution of AHC in 94% of patients. Our results provide a rationale for delaying treatment for 12 weeks, targeting only patients who fail to clear the virus spontaneously and truly requiring therapy without loss of efficacy.