- Design
- Systematic review and meta-analysis of single-arm studies
- Population
- 1,078 people with acute or recently acquired HCV, 14 studies
- Primary outcome
- SVR12
- Effect
- Pooled 97.7% (95% CI 94.7–99.1); 4 weeks 84.8%, 8 weeks 99.4%
A meta-analysis pooled 14 studies with 1,078 people treated with two direct-acting antivirals, without interferon, for acute or recently acquired hepatitis C, mostly men who have sex with men living with HIV and people who inject drugs.
Overall SVR12 was 97.7%. Cure rose with treatment duration: 85% with four weeks, 92% with six, 99% with eight and 97% with twelve. It did not differ by regimen or by HIV status.
The studies were mostly single-arm, and regimen and duration overlapped, so the duration effect is not proof from randomised comparison. But the message is clear: do not wait for spontaneous clearance in high-risk groups where onward transmission is the concern, and do not shorten below eight weeks. In India, where recent infection is often detected through screening of people who inject drugs or dialysis patients, early treatment also interrupts local outbreaks.
- Consider treating recently acquired hepatitis C promptly rather than waiting for spontaneous clearance in high-risk groups.
- Use a course of at least eight weeks; shorter courses had lower cure rates.
- Treat regardless of HIV co-infection status, which did not affect cure.
- Retest for reinfection at intervals in people with ongoing risk.
Why it matters
Early cure stops transmission in the networks where acute infections cluster.
Don't overread it
Mostly single-arm studies; the duration finding is not from randomised comparison.
The statistics, in plain English
Pooled cure of 97.7% (95% CI 94.7 to 99.1) is high and consistent (I² 30%). The fall to 85% at four weeks is the important signal, but because each duration came from different studies, other differences could contribute.
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