“Wait-and-See”: An Alternative Approach to Managing Acute Hepatitis C with High-Dose Interferon-α Monotherapy
Authors: Neville R. Pimstone, Daniel Pimstone, Theparat Saicheur, Jerry Powell, Andy S. Yu
Journal: Annals of Internal Medicine (2004)

Letters21 September 2004“Wait-and-See”: An Alternative Approach to Managing Acute Hepatitis C with High-Dose Interferon-α MonotherapyNeville R. Pimstone, MD, PhD, Daniel Pimstone, BSc, Theparat Saicheur, DVM, PhD, Jerry Powell, MD, and Andy S. Yu, MDNeville R. Pimstone, MD, PhDFrom University of California, Davis, Medical Center, Sacramento, CA 95817, and Stanford University Medical Center, Stanford, CA 94305.Search for more papers by this author, Daniel Pimstone, BScFrom University of California, Davis, Medical Center, Sacramento, CA 95817, and Stanford University Medical Center, Stanford, CA 94305.Search for more papers by this author, Theparat Saicheur, DVM, PhDFrom University of California, Davis, Medical Center, Sacramento, CA 95817, and Stanford University Medical Center, Stanford, CA 94305.Search for more papers by this author, Jerry Powell, MDFrom University of California, Davis, Medical Center, Sacramento, CA 95817, and Stanford University Medical Center, Stanford, CA 94305.Search for more papers by this author, and Andy S. Yu, MDFrom University of California, Davis, Medical Center, Sacramento, CA 95817, and Stanford University Medical Center, Stanford, CA 94305.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-6-200409210-00031-w1 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Background: The treatment of acute hepatitis C (that is, infection within 6 months of exposure) remains an open question. (Management of Hepatitis C: 2002, 10–12 June 2002, NIH Consensus 2 developmental meeting on hepatitis C). In a clinical trial by Jaeckel and colleagues (1), all acutely infected patients (n = 45) were treated empirically with interferon-α2b monotherapy for 6 months; 43 (98%) achieved a sustained virologic response. This is becoming the standard of care. Some treated patients (10% to 67%) would have achieved spontaneous virologic recovery (particularly if they were icteric [2-4]) and would not have needed interferon, ...References1. Jaeckel E, Cornberg M, Wedemeyer H, Santantonio T, Mayer J, Zankel M, et al . Treatment of acute hepatitis C with interferon alfa-2b. N Engl J Med. 2001;345:1452-7. [PMID: 11794193] CrossrefMedlineGoogle Scholar2. Hofer H, Watkins-Riedel T, Janata O, Penner E, Holzmann H, Steindl-Munda P, et al . Spontaneous viral clearance in patients with acute hepatitis C can be predicted by repeated measurements of serum viral load. Hepatology. 2003;37:60-4. [PMID: 12500189] CrossrefMedlineGoogle Scholar3. Gerlach JT, Diepolder HM, Zachoval R, Gruener NH, Jung MC, Ulsenheimer A, et al . Acute hepatitis C: high rate of both spontaneous and treatment-induced viral clearance. Gastroenterology. 2003;125:80-8. [PMID: 12851873] CrossrefMedlineGoogle Scholar4. Santantonio T, Mazzola M, Guastadisegni A, Casalino C, Pastore G. A cohort study of acute hepatitis C virus (HCV) infection: natural course and outcome [Abstract]. Hepatology. 1999;30:205A. Google Scholar5. Hoofnagle JH. Therapy for acute hepatitis C [Editorial]. N Engl J Med. 2001;345:1495-7. [PMID: 11794202] CrossrefMedlineGoogle Scholar6. Alter HJ. New kit on the block: evaluation of second-generation assays for detection of antibody to the hepatitis C virus [Editorial]. Hepatology. 1992;15:350-3. [PMID: 1310478] CrossrefMedlineGoogle Scholar7. Cucchiarini M, Kammer AR, Grabscheid B, Diepolder HM, Gerlach TJ, Gruner N, et al . Vigorous peripheral blood cytotoxic T cell response during the acute phase of hepatitis C virus infection. Cell Immunol. 2000;203:111-23. [PMID: 11006009] CrossrefMedlineGoogle Scholar8. Lam NP, Neumann AU, Gretch DR, Wiley TE, Perelson AS, Layden TJ. Dose-dependent acute clearance of hepatitis C genotype 1 virus with interferon alfa. Hepatology. 1997;26:226-31. [PMID: 9214474] CrossrefMedlineGoogle Scholar9. Karino Y, Toyota J, Sugawara M, Higashino K, Sato T, Ohmura T, et al . Early loss of serum hepatitis C virus RNA can predict a sustained response to interferon therapy in patients with chronic hepatitis C. Am J Gastroenterol. 1997;92:61-5. [PMID: 8995939] MedlineGoogle Scholar10. Zeuzem S, Feinman SV, Rasenack J, Heathcote EJ, Lai MY, Gane E, et al . Peginterferon alfa-2a in patients with chronic hepatitis C. N Engl J Med. 2000;343:1666-72. [PMID: 11106715] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of California, Davis, Medical Center, Sacramento, CA 95817, and Stanford University Medical Center, Stanford, CA 94305.Note: This study was presented in part at the Digestive Disease Week 2000 meeting, San Diego, California, 20–24 May 2000, and at the International Association for the Study of the Liver—Asian Pacific Association for the Study of the Liver joint meeting, Fukuoka, Japan, 2–7 June 2000.Grant Support: By Schering Oncology/Biotech. 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