Acute hepatitis C: pooled cure was 99% with eight weeks of dual DAA therapy and lower with shorter courses

Design

Systematic review and meta-analysis of 14 studies, mostly single-arm, random-intercept logistic model

Population

1,078 treated patients with acute or recently acquired HCV

Primary outcome

SVR12 overall and by treatment duration, regimen and HIV status

Effect

Pooled SVR12 97.7% (95% CI 94.7 to 99.1); 8 weeks 99.4% (97.5 to 99.9); 6 weeks 91.7%; 4 weeks 84.8%

This systematic review and meta-analysis pooled 14 studies (19 single-arm analysis units, 1,078 treated patients) of interferon-free dual direct-acting antiviral therapy in acute or recently acquired hepatitis C, common in men who have sex with men living with HIV and in people who inject drugs. Most were single-arm series.

Pooled SVR12 was 97.7% (95% CI 94.7 to 99.1; I-squared 30.4%). It rose with treatment duration: 84.8% (74.1 to 91.6) at 4 weeks, 91.7% (86.2 to 95.1) at 6 weeks, 99.4% (97.5 to 99.9) at 8 weeks and 97.4% (91.7 to 99.2) at 12 weeks (between-subgroup P<0.001). Cure did not differ by regimen (P=0.608), study design (P=0.764) or HIV status (P=0.975). The estimate was stable across sensitivity analyses.

The authors favour a course of at least eight weeks and early treatment, and call for randomised duration trials because the evidence is mostly single-arm and regimen is partly confounded with duration.

• The authors support early treatment of acute and recently acquired hepatitis C, which also matters for onward transmission.
• A course of at least 8 weeks gave about 99% SVR12 in pooled data; 4- and 6-week courses gave lower cure.
• Cure rates did not differ by HIV status in this analysis.
• Follow patients for SVR12 and discuss reinfection risk.
• Check current national guidance for the recommended duration in acute infection.

Why it matters

It gives a floor for treatment duration in a group where short courses are tempting.

Don't overread it

Mostly single-arm evidence, and regimen is partly confounded with duration, as the authors state.

The statistics, in plain English

Pooled single-arm proportions cannot compare regimens directly, because patients and settings differ between studies. The jump from 91.7% at 6 weeks to 99.4% at 8 weeks is a between-study contrast, which is weaker evidence than a randomised comparison.

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